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OUD

CE / CME

Module 6: Opioid Use Disorder

Physician Assistants/Physician Associates: 1.00 AAPA Category 1 CME credit

Nurses: 1.00 Nursing contact hour

ABIM MOC: maximum of 1.00 Medical Knowledge MOC point

Optometrists: 1.00 COPE CE credit 

ABP MOC: maximum of 1.00 MOC point

ABS MOC: maximum of 1.00 Continuous Certification credit

ABOHNS MOC: maximum of 1.00 Part II Self-Assessment Credit

ABPath MOC: maximum of 1.00 Lifelong Learning point

Dental Professionals: 1.00 ADA CERP credit

Physicians: maximum of 1.00 AMA PRA Category 1 Credit™

Released: May 31, 2023

Expiration: May 30, 2026

Timothy Atkinson
Timothy Atkinson, PharmD, BCPS, CPE
CME/CE Information

Activity

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Course Completed

Buprenorphine Pharmacology

Buprenorphine is the only opioid for which prescribing has increased over the past few years. There are many new formulations of buprenorphine in the pipeline. It really is a unique drug.34-36

Buprenorphine is a μ-opioid partial agonist. It is a very large molecule with slow receptor association and slow dissociation. Buprenorphine also binds with high affinity to kappa and delta opioid receptors. There is very good receptor saturation with even 2 mg of a sublingual buprenorphine tablet (similar to 30 mg of morphine). With a dose of 16 mg—the standard—79% to 95% of opioid receptors are saturated. For acute postoperative pain, the dose may be decreased and supplemented with opioids.

Buprenorphine is much more potent than morphine. It is also more potent at displacing fentanyl. It takes 40 times the amount of naloxone to displace and reverse buprenorphine compared with fentanyl.

Buprenorphine has a very long half life. That is important to remember because when healthcare professionals try to use naloxone to reverse buprenorphine, multiple doses of naloxone may be needed, because naloxone has a very short half life. 

Comparison of Buprenorphine Formulations

There are many formulations of buprenorphine available on the market.37,38 There are sublingual and film formulations that have been used for OUD. There are injectable subcutaneous depot formulations for weekly or monthly treatment that have become popular and are used for OUD treatment as well. 

Payor Priorities vs Guideline Recommendations (Buprenorphine)

Let’s circle back to payor priorities vs guideline recommendations. When it comes to patient follow-up and monitoring, payors like to see a time limited duration of treatment—6 months to a maximum of 1 year—then requiring patients to be tapered off treatment.

Guidelines, on the other hand, are clear that longer durations of treatment are more effective. There is no evidence that discharging patients based on an artificial timeline is either safe or effective. Because this is a life-saving treatment, any time there is a gap in treatment, that gap can pose a risk for the patient.

Dosage limits are also common for third-party payors. They often limit the buprenorphine dose to 8-16 mg, whereas some patients may need 20 mg or 24 mg; according to SAMHSA, some patients may need as much as 32 mg.

Visit frequency should also be on a stable schedule according to the guidelines, but because of low reimbursement rates with Medicaid, some clinics only see their patients weekly or biweekly. This is an effort to compensate for the gap in reimbursement rates with Medicaid compared with other payors.

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