Can a Primary Care Physician (PCP) prescribe Suboxone (buprenorphine) for opioid use disorder?

From the Guidelines

No, a Primary Care Physician (PCP) cannot prescribe Suboxone (buprenorphine) for opioid use disorder without special authorization, as they must obtain a special waiver, commonly known as an "X-waiver," by completing additional training requirements and applying through the Substance Abuse and Mental Health Services Administration (SAMHSA) 1. This training typically involves 8-24 hours of education on addiction treatment. Once waivered, physicians can prescribe buprenorphine to a limited number of patients, starting with 30 patients in the first year and potentially increasing to 100 or 275 patients with additional experience and qualifications. The restriction exists because buprenorphine is a partial opioid agonist that requires specialized knowledge for proper prescribing and monitoring. The medication works by binding to opioid receptors to reduce cravings and withdrawal symptoms while producing less euphoria than full opioids. Some key points to consider include:

• Buprenorphine has been shown to be safe and effective in treating opioid use disorder, with studies demonstrating its efficacy in reducing cravings and withdrawal symptoms 1.
• The Substance Abuse and Mental Health Services Administration (SAMHSA) requires physicians to complete a training program to obtain a waiver to prescribe buprenorphine 1.
• Patients seeking Suboxone treatment should ask their PCP for a referral to a waivered physician or addiction specialist if their doctor doesn't have the necessary authorization.
• The American College of Physicians (ACP) recommends that physicians become familiar with and follow clinical guidelines related to pain management and controlled substances, including buprenorphine 1.

From the Research

Can a Primary Care Physician (PCP) Prescribe Suboxone?

• A Primary Care Physician (PCP) can prescribe Suboxone (buprenorphine) for opioid use disorder, as it is one of the medications approved by the US Food and Drug Administration for this purpose 2, 3.
• Buprenorphine, the active ingredient in Suboxone, is a partial opioid agonist that can help suppress opioid withdrawal symptoms and reduce cravings 4, 5.
• Studies have shown that buprenorphine is effective in treating opioid use disorder, although it may have a lower treatment retention rate compared to methadone 6.
• PCPs can play a crucial role in prescribing buprenorphine and providing ongoing care and support to patients with opioid use disorder, especially in primary care settings where access to specialty care may be limited 5.

Key Considerations for PCPs Prescribing Suboxone

• PCPs should consider individual patient characteristics and preferences when deciding whether to prescribe buprenorphine or methadone 5.
• Buprenorphine may be preferred for patients who are socially stable, have a lower risk of overdose, and require less frequent monitoring 5.
• PCPs should also be aware of the potential risks and benefits of buprenorphine treatment, including the risk of diversion and misuse, and take steps to minimize these risks 4, 2.
• Ongoing education and training for PCPs on the use of buprenorphine and other medications for opioid use disorder can help improve treatment outcomes and reduce the risk of overdose and other adverse events 3.