18 Va. Admin. Code § 85-21-150

Current through Register Vol. 41, No. 8, December 2, 2024

Section 18VAC85-21-150 - [Effective 1/2/2025] Treatment with buprenorphine for opioid use disorder

A. Buprenorphine without naloxone (buprenorphine mono-product) shall not be prescribed except:

1. When a patient is pregnant;

2. When converting a patient from methadone or buprenorphine mono-product to buprenorphine containing naloxone for a period not to exceed seven days;

3. In formulations other than tablet form for indications approved by the FDA; or

4. For patients who have a demonstrated intolerance to naloxone; such prescriptions for the mono-product shall not exceed 3.0% of the total prescriptions for buprenorphine written by the prescriber, and the exception shall be clearly documented in the patient's medical record.

B. Buprenorphine mono-product tablets may be administered directly to patients in federally licensed opioid treatment programs. With the exception of those conditions listed in subsection A of this section, only the buprenorphine product containingnaloxone shall be prescribed or dispensed for use off site from the program.

C. The evidence for the decision to use buprenorphine mono-product shall be fully documented in the medical record.

D. Due to a higher risk of fatal overdose when buprenorphine is prescribed with other opioids, benzodiazepines, sedative hypnotics, carisoprodol, and tramadol (an atypical opioid), the prescriber shall only co-prescribe these substances when there are extenuating circumstances and shall document in the medical record a tapering plan to achieve the lowest possible effective dosesif these medications are prescribed.

E. Prior to starting medications for opioid use disorder, the practitioner shall perform a check of the Prescription Monitoring Program.

F. During the induction phase, dosage shall be based on the patient's history and current usage, including exposure to high-potency opioids. The patient shall be evaluated by the prescriber at least once a week.

G. During the stabilization phase, the prescriber shall increase the daily dosage of buprenorphine in safe and effective increments to achieve the lowest dose that avoids intoxication, withdrawal, or significant drug craving.

H. Practitioners shall take steps to reduce the chances of buprenorphine diversion and misuse by using the lowest effective dose, appropriate frequency of office visits, pill counts, and checks of the Prescription Monitoring Program. The practitioner shall also require urine drug screens or serum medication levels at least every three months for the first year of treatment and at least every six months thereafter.

I. Documentation of the rationale for prescribed doses exceeding 24 milligrams of buprenorphine per day shall be placed in the medical record.

J. The practitioner shall incorporate relapse prevention strategies into counseling or document referral to a mental health service provider, as defined in § 54.1-2400.1 of the Code of Virginia.

18 Va. Admin. Code § 85-21-150

Derived From Virginia Register Volume 34, Issue 23, eff. 8/8/2018; Amended, Virginia Register Volume 41, Issue 7, eff. 1/2/2025.

Statutory Authority: §§ 54.1-2400 and 54.1-2928.2 of the Code of Virginia.