Meanwhile, as the DEA continues to work on the regulation, the agency announced a few weeks ago, on March 23, that it would allow a waiver of the current three-day rule requirement that practitioners administer medication to patients for one day. In keeping with the purpose of the Easy MAT Act, practitioners who wish to dispense drugs to patients at the same time for the full three days can submit a request to the DEA for authorization to do so. A 30-step exemption allows providers who want to treat up to 30 patients to prescribe buprenorphine. For this level exemption, physicians require 8 hours of training and APRN or PA require 24 hours of training. The purpose of 21 CFR 1306.07(b) is to provide the physician with flexibility in emergency situations where faced with a patient withdrawing. In such emergency situations, it is not practical to require practitioners to register separately. The 72-hour exemption provides individual opioid relief from acute withdrawal symptoms while the physician arranges placement in a maintenance/detoxification treatment program. This provision was introduced in order to complement the separate registration obligation and not to circumvent it. The three-day (72-hour) emergency exemption cannot be extended or extended. The old “three-day rule” allowed emergency physicians to initiate buprenorphine treatment for opioid use disorder (OUD), but patients had to return to the emergency room within the 72-hour window to receive additional doses pending arrangements for long-term treatment.
The Drug Enforcement Administration (DEA) allows prescription without waiver under the “three-day rule” (Title 21, Code of Federal Regulations, Part 1306.07(b)), which allows a physician to administer (but not prescribe) narcotics to a patient to relieve acute withdrawal symptoms while arranging patient referral for treatment. under the following conditions: 1) a patient must not receive or receive medication for more than one day; (2) This treatment must not be carried out for more than 72 hours; and (3) this 72-hour period cannot be extended or extended. Emergency physicians can dispense buprenorphine without X exemption, as long as it is only a three-day supply. However, emergency physicians still need an X waiver to prescribe buprenorphine, which the patient can access outside the emergency room after discharge. (CAPE also remains committed to changing this rule.) In general, start with 4-8 mg as a sublingual tablet (Suboxone or Subutex) under the tongue. IV buprenorphine (0.3 mg) can be used in patients who cannot tolerate sublingual tablets. When the tablets are swallowed, very little buprenorphine is absorbed. Repeated doses of up to 32 mg SL may be administered depending on the clinical situation. It is acceptable to administer buprenorphine in areas of low visual acuity, the “accelerated” area of erectile dysfunction.
A single dose of 8 mg has a maximum effect of about one hour and controls withdrawal symptoms for 6 to 12 hours. Transdermal buprenorphine is usually too weak to prevent withdrawal symptoms and is best used in patients with chronic pain. CAPE has been working on this topic for several years. CAPE Officers and D.C. Members Employees met with the Substance Abuse and Mental Health Services Administration (SAMHSA) and HHS on several occasions and included a specific request to change the three-day rule in numerous letters to the administration and Congress. The three-day rule allows practitioners to administer medications that cannot be extended or extended for up to three days for more than one day. During the three-day period, the provider must arrange for referral of the patient for treatment as part of a maintenance or detoxification program. The purpose of the three-day rule is to give health care providers flexibility to respond to emergency situations when a patient is acutely weaned. Some providers are taking advantage of the flexibility offered by the three-day rule and offering withdrawal treatment services to meet the growing demand for withdrawal treatment due to the opioid and other substance crisis. However, before undertaking such processing, a provider should be aware of the applicable rules and regulations governing such processing. Sublingual buprenorphine takes 15 minutes to work when held under the tongue and peaks in one hour.
A typical intravenous buprenorphine of 0.3 mg begins to act immediately after maximum intravenous relapse within 5 to 10 minutes. Generally, federal law requires practitioners to obtain Drug Enforcement Agency (DEA) registration or an exemption from DEA registration to use narcotics to treat opioid addiction. Under an exemption from the DEA`s registration requirements known as the “three-day rule,” practitioners who are not otherwise registered with the DEA or who have not received an exemption may administer narcotics to patients for up to 72 hours, but do not prescribe them.
