Buprenorphine
/ naloxone has many similarities with methadone. It is approved in
Canada for the treatment of opioid use disorder. There have been reports
of errors during the dispensing process as a result of pharmacy teams
not understanding the many unique elements in dispensing
buprenorphine/naloxone sublingual tablets.
In order to provide buprenorphine treatment safely to patients, an article by the Centre for Addiction and Mental Health (CAMH) advises pharmacists to keep the following in mind:
1. Indication: Opioid dependence treatment is the most frequent, and the only approved, indication for buprenorphine/naloxone.
2. Pay attention to start and stop dates: Start and stop dates for dispensing are usually (and preferably) used instead of the total numerical quantity of doses needed.
3. Missed doses are not “owing doses:” If a patient
misses buprenorphine/naloxone doses on days during the interval
indicated by the start and stop dates, these doses are not considered as
“owing” to the patient.
4. Observed and take-home doses: Supervised dosing by
the pharmacist is an important clinical component. This involves
carefully, respectfully and discretely witnessing a patient placing the
tablet(s) under the tongue and observing dissolution. Carry doses must
be dispensed in a child-proof container.
5. Tracking missed doses and communicating with the prescriber:
Information about missed doses is essential for the prescriber in
making clinical decisions regarding buprenorphine therapy and for the
pharmacist to medicate their patients safely. As with methadone, it is
good practice to inform the prescriber of each missed dose.
Read the full CAMH article, 5 Things to Know about Prescriptions for Buprenorphine /Naloxone, to safely provide buprenorphine treatment to patients.
Additional buprenorphine resources can be found on the College’s Methadone and Buprenorphine practice tool.
