Provider Resources

Find information on opioid prescribing, naloxone co-prescribing, and medications for opioid use disorder below. 

Ready to prescribe medications for opioid use disorder?

Due to the recent change in MAT-waiver guidelines, it is now easier than ever to begin prescribing buprenorphine for opioid use disorder.

Providers interested in prescribing buprenorphine will need to submit a notice of intent (NOI) to SAMHSA. Upon submission, providers are permitted to prescribe buprenorphine for up to 30 patients. 

Learn more about the NOI requirements 

If you are interested in prescribing buprenorphine to more than 30 patients, you are required to complete the MAT-waiver training. This training may be 8- or 24-hours, depending on your level of practitioner license. Project ECHO Idaho hosts bi-annual hybrid DATA 2000 MAT-Waiver trainings for providers. 

Are you a ready to become MAT waivered? Register for an upcoming training 

 

Idaho Board of Medicine policy for the use of opioid analgesics
Idaho Academy of Family Physicians article on PDMP mandatory checking

Provider resources

Signs of opioid misuse

As a healthcare provider, you have a responsibility to ensure controlled substances are prescribed solely for a genuine medical need.

While there's no uniform way to identify medication misuse, there are some common signs you may see:
  • Assertive personality (e.g., demanding immediate action)
  • Unusual knowledge of controlled substances
  • Gives medical history with textbook answers or gives vague answers relating to their medical history
  • May request a specific drug and be reluctant to try something different
  • No interest in diagnosis and often fails to keep appointments for further diagnostic tests or consultation with another practitioner
  • Patient may decline permission to obtain past records                                                               
  • Claims to be a patient of a practitioner that is not currently available
  • Has multiple unexplained dose escalation or non-adherence to treatment plans
Naloxone co-prescribing

Naloxone co-prescribing is one important tool prescribers can use to help prevent opioid overdose deaths. Co-prescribing naloxone is strongly recommended for patients at-risk for opioid overdose. In continuing these efforts, prescribers and other healthcare providers can monitor patients for risk of overdose, prescribe or dispense naloxone when overdose risk factors are present, and teach patients on how to use it.

Naloxone is not currently available over-the-counter. However, Idaho’s law allows pharmacists and other health professionals to prescribe and dispense to anyone at risk for an opioid-related overdose or to anyone who may encounter such an individual.

MME calculator
Calculating the total daily dose of opioids helps identify patients who are at higher risk of overdose. 

Use extra precautions for patients at ≥50 MME/day. Consider closely monitoring patients, reducing or tapering of opioids, and/or prescribing of naloxone. Avoid or carefully justify increasing dosage to ≥90 MME/day.

Calculating MME

1. Determine the total daily amount of each opioid the patient takes

2. Convert each to MME — multiply the dose for each opioid by the conversion factor (see table)

3. Add them together

Select the link to access a free opioid dose calculator 

Tapering dosages
Consider tapering to a reduced opioid dosage, or tapering and discontinuing opioid therapy, when:
  • Pain improves
  • The patient requests dosage reduction or discontinuation
  • Pain and function are not meaningfully improved
  • The patient is receiving higher opioid doses without evidence of benefit from the higher dose
  • The patient has current evidence of opioid misuse
  • The patient experiences side effects that diminish quality of life or impair function
  • The patient experiences an overdose or other serious event (e.g., hospitalization, injury) or is in a high-risk situation
  • The patient is receiving medications (e.g., benzodiazepines) or has medical conditions that increase risk for adverse outcomes

(Source: U.S. Department of Health and Human Services)

For more guidance on tapering opioid prescriptions, refer to the CDC’s video: “Tapering Opioids for Chronic Pain”

Idaho Prescription Drug Monitoring Program (PDMP)

The Idaho PDMP is a statewide electronic database that collects designated data on controlled substances dispensed in Idaho. The Idaho PDMP is connected with PDMPs in neighboring states. This tool is for prescribers of controlled substances and pharmacists who are considering dispensing controlled substance prescriptions to patients.

The Idaho PDMP serves several purposes:

  • Supports access to legitimate medical use of controlled substances
  • Identifies and deters or prevents drug abuse and diversion
  • Helps identify and facilitates treatment of person with opioid use disorder (or substance use disorder)
  • Avoids dangerous combinations of benzodiazepines and opioids
  • Informs public health initiatives through analysis of the PDMP database

Beginning October 1, 2020, Idaho providers are required to check the PDMP prior to issuing an opioid or benzodiazepine prescription that is for more than a 3-day supply.

Click the link to login and register for the Idaho PDMP: https://idaho.pmpaware.net

Medication for opioid use disorder resources

Opioid use disorder (OUD)

The American Society of Addiction Medicine (ASAM) defines addiction as a “treatable, chronic medical disease”.

Addiction involves a complex interplay of interactions among brain circuits, genetics, the environment, and an individual’s life experiences. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. When compared to dependence upon medications, the defining feature of addiction is that individuals with addiction will use substances or engage in behaviors that become compulsive and continue despite harmful consequences.

Opioid use disorder (OUD) is the chronic disease of opioid addiction. Like many chronic conditions, such as type 2 diabetes, medication is needed to improve the disease management process. Medications for Addiction Treatment (MAT) allows patients who wish to treat their opioid use disorder in an evidence-based manner the ability to do so.

Select the link to learn more about opioid use disorder

Screening tools

Find resources to screen your patients for opioid use disorder, opioid withdrawal, and social and medical histories below: 

Analyze the severity of the patient’s OUD based on current drug use patterns: DSM5 

Assess patient's medical history: Buprenorphine/Naloxone Maintenance Treatment Intake Questionnaire for Patient Treatment-Planning Questions

Assess medical and social history and identify an effective treatment plan: Buprenorphine/Naloxone Maintenance Treatment Intake Questionnaire for Patient Treatment-Planning Questions

Assess levels of opioid withdrawal among patients: Clinical Opioid Withdrawal Scale (COWS)

Screen severity of patient OUD and refer their patients to OUD treatment services: Screening, Brief Intervention, and Referral to Treatment (SBIRT)

Medications for opioid use disorder

Currently, there are three FDA-approved medications available to treat opioid use disorder (OUD)—buprenorphine, methadone, and naltrexone.

Medications for opioid use disorder (MOUD) give people the time and ability to make necessary life changes associated with long-term recovery. As a result of taking medications for opioid use disorder, a threshold of mood-stabilizing neurotransmitters like dopamine is met. By taking MOUD, patients with OUD can focus on other things without strong cravings or withdrawal symptoms.

Select the link to learn more about medications for opioid use disorder 

 

Evidence-base

Medications for opioid use disorder (MOUD) have shown to improve patient survival, increase retention in treatment, decrease illicit opiate use, and other criminal activity among people with substance use disorders. MOUD increases patients’ ability to gain and maintain employment and improves birth outcomes among women who have substance use disorders and are pregnant. Research also supports the shared understanding that these medications and therapies can contribute to lowering a person’s risk of contracting HIV or hepatitis C (Source: SAMHSA).

Research demonstrates that access to FDA-approved medications alone for the treatment of opioid use disorder saves lives and promotes recovery. Therefore, limited, or absent behavioral health resources should not be a barrier to starting patients on medications for opioid use disorder. Select the link the full research article

MOUD initiation resources

Download the documents below to assist in your MOUD clinic workflow: 

Sample MAT Program Consent Form (Courtesy of Marimn Health)

Sample Clinical Induction Protocol

Sample Opioid Use Disorder Primary Care Pathway 

Did you know? The University of Idaho’s Project ECHO (Extension for Community Healthcare Outcomes) offers twice-monthly peer-led educational webinars on substance use disorder. They also offer hybrid MAT-waiver trainings throughout the year. Select the link to learn more about Project ECHO Idaho

Buprenorphine induction resources

Download the documents below to assist in buprenorphine prescribing practices: 

Buprenorphine Quick Start Guide

Sample Buprenorphine Consent Form (Courtesy of Marimn Health)

Checklist for Buprenorphine Induction (Courtesy of Marimn Health)

PCSS MAT Guidance for Buprenorphine Induction

Want more resources? Find clinical tools and educational resources for buprenorphine prescribing on the PCSS website 

Ready to prescribe buprenorphine? Submit your notice of intent through the SAMHSA website

 

Earn free CE/CME

Opioid prescribing guideline and use of the Idaho Prescription Drug Monitoring Program

Title: Opioid Prescribing Guideline and Use of the Idaho Prescription Drug Monitoring Program

Original Release Date: September 1, 2018

Review Date: September 1, 2020

Re-release date: June 1, 2021

Expiration date: May 31, 2023

Target audience

This learning activity is designed for Idaho healthcare prescribers.

Educational objectives

Upon completion of this educational activity, participants should be able to:

  1. Describe the opioid epidemic in Idaho 
  2. Integrate CDC’s Guideline for Prescribing Opioids for Chronic Pain in provider practices
  3. Create and interpret PDMP data reports
  4. Use patient prescription history to inform clinical decision-making
  5. Identify the warning signs of medication misuse in patients

Accreditation

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the Federation of State Medical Boards, the Idaho State Board of Medicine and the Idaho Department of Health and Welfare. The Federation of State Medical Boards is accredited by the ACCME to provide continuing medical education for physicians.

Credit designation

The Federation of State Medical Boards designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The Federation of State Medical Boards certifies that non-physicians will receive a participation certificate stating that they participated in the enduring material that was designated for 1.0 AMA PRA Category 1 Credit™.

Course director and presenter

Magni Hamso, MD, MPH

Medical Director, Idaho Department of Health and Welfare, Division of Medicaid

Staff Physician, Boise VA Medical Center 

Dr. Hamso is the medical director for Idaho Department of Health and Welfare’s Division of Medicaid.  She is a clinical assistant professor at the University of Washington and a part-time staff physician at the Boise VA, where she cares for veterans with chronic pain and opioid use disorder and teaches students and residents.  She is board-certified in internal medicine and addiction medicine. She attended college at Yale University and medical and public health school at Columbia University. She completed her residency and chief residency at Montefiore/Einstein’s Primary Care and Social Internal Medicine Residency Program in the Bronx, New York. 

Commercial support

This learning activity is not funded by any commercial entity.

Disclosure of commercial interest

As an organization accredited by the ACCME, the Federation of State Medical Boards (FSMB) requires that the content of CME activities and related materials provide balance, independence, objectivity, and scientific rigor. Planning must be free of the influence or control of a commercial entity and promote improvements or quality in healthcare. Anyone in the position to control the content of an education activity are required to disclose all relevant financial relationships in any amount occurring within the past 12 months with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on patients.

The ACCME defines “relevant financial relationships” as financial relationships in any amount occurring within the past 12 months that create a conflict of interest. The FSMB has implemented a mechanism to identify and resolve all conflicts of interest before the activity. The intent of this policy is to identify potential conflicts of interest so participants can form their own judgments with full disclosure of the facts. Participants will be asked to evaluate whether the speaker’s outside interests reflect a possible bias in the planning or presentation of the activity. 

The speaker, course director, and planners at the Federation of State Medical Boards, the Idaho State Board of Medicine, and the Idaho Department of Health and Welfare have no relevant financial interests to disclose.

Disclosure of unlabeled uses

This educational activity may contain discussion of published and/or investigational uses of agents that are not approved by the U.S. Food and Drug Administration. For additional information about approved uses, including approved indications, contraindications, and warnings, refer to the prescribing information for each product, or consult the "Physicians’ Desk Reference."

Faculty and staff disclosures

No speakers or people in control of content reported intent to reference unlabeled/unapproved uses of drugs or products.