Why we are recommending this best practice
Strategies for implementation
- Pull in the whole team. Successful integration of a new service will require front office, back office, and providers all educated about the successful outcomes in pregnant women with OUD who are on MAT.
- Providers must receive a Drug Addiction Treatment Act of 2000 (DATA 2000) X waiver. Federal legislation (SUPPORT Act, 2018) and previous legislation includes CNMs, NPs, and CRNAs in addition to physicians as eligible to complete this training. Physicians require 8 hours of training, and non-physician providers require 24 hours of training.
- Build policies/procedures. Having these in place will allow for a uniform care delivery system.
- Use a toolkit. Numerous toolkits exist that provide clinics with the education and resources needed to offer MAT. One such is example is the Providers Clinical Support System (PCSS). https://pcssnow.org/resources/clinical-tools/
- Know who to call for help. Know how to refer patients who fail buprenorphine to methadone treatment programs when necessary. Consider using a consultation service such as the FREE Clinician Consultation Center at UCSF which has a Substance Use Warmline at 855-300-9595 and is available Monday through Friday between 9am and 8pm ET. This line is staffed by physicians, pharmacists, and nurses with special expertise in pharmacotherapy options.
- Explore emerging therapies. Aside from traditional in-office induction, consider other modalities that best suit your patients. These include home and hospital induction, microdosing transition, and Buprenorphine Quick Start.
- SAMHSA Waiver Application and Training.
- Providers Clinical Support System (PCSS). Clinical Tools.
- Guidelines for Physicians Working in California Opioid Treatment Programs. Chapter 4.
- ED Bridge. Buprenorphine Quick Start in Pregnancy Algorithm.
- California Health Care Foundation Webinar: “Expanding Access to Buprenorphine in Primary Care Settings”.
- California Health Care Foundation. Everything You Need to Know About Buprenorphine.
- Urban Institute: California County Fact Sheets: Treatment Gaps in Opioid-Agonist Medication Assisted Therapy (OA-MAT) and Estimates of How Many Additional Prescribers Are Needed.
- Laws and Regulations. Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/about-us/who-we-are/laws-regulations.
- Apply for a Practitioner Waiver. Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/medication-assisted-treatment/training-materials-resources/apply-for-practitioner-waiver.