The Physician's Role in Preventing Abuse and Diversion
Physicians who provide buprenorphine treatment are DEA registrants and have a legal responsibility to take reasonable measures to prevent abuse and diversion. These physicians are required to determine a legitimate medical purpose for the patient to be prescribed the controlled substance and act in the usual course of professional practice. Clinicians should keep notes in each patient's medical record to provide evidence to support the prescription (Gibbs and Haddox, 2003).
In order to prescribe buprenorphine lawfully, physicians must never:
- Prescribe to a patient who routinely does not test positive for buprenorphine or its metabolites on drug screens
- Prescribe a dosage level that is not supported by the pharmacology of buprenorphine (Gibbs and Haddox, 2003)
Further, if a physician has knowledge that a patient's buprenorphine will be used for an non-medical purpose, it is illegal for him or her to dispense or prescribe to that patient. If you admit a patient with a prior history of drug abuse to buprenorphine treatment, having a patient contract with provisions for random urine testing and pill counts is important.
Additional regulations to be aware of regarding abuse and diversion:
Original container laws: Many states have controlled substance laws that prohibit patients from removing their buprenorphine prescriptions from the original container when traveling, and in some cases, when driving.
For example, New York's law states that:
Possession of controlled substances by ultimate users original container. Except for the purpose of current use by the person or animal for whom such substance was prescribed or dispensed, it shall be unlawful for an ultimate user of controlled substances to possess such substance outside of the original container in which it was dispensed. Violation of this provision shall be an offense punishable by a fine of not more than fifty dollars.
There are several tips for your patient who is traveling and cannot or does not want to take the full original prescription bottle:
- Some pharmacies provide smaller zip-lock bags into which they can divide the tablets up and put a label on each one
- Have your patients keep a photocopy of the prescription label with them