Changes to PPP-66 Policy Guide: Buprenorphine/Naloxone Maintenance Treatment

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As of June 1, 2024, changes to PPP-66 Policy Guide: Buprenorphine/Naloxone Maintenance Treatment, specifically Principle 5.1.1 and 5.1.4 under section ‘5.0 Responding to Buprenorphine/Naloxone Dosing Issues’ will come into effect to reflect the most recent changes to the BC Centre on Substance Use A Guideline for the Clinical Management of Opioid Use Disorder (OUD Guideline).

As a reminder, the PPP-66 Buprenorphine/Naloxone Policy Statements require that all pharmacy managers, staff pharmacists, relief pharmacists, and pharmacy technicians employed in a community pharmacy that provides pharmacy services related to buprenorphine/naloxone maintenance treatment must know and apply the principles and guidelines outlined in the PPP-66 Policy Guide and be familiar with the information included in the most recent OUD Guideline.

The changes to the PPP-66 Policy Guide: Buprenorphine/Naloxone Maintenance Treatment are summarized below:

Principle	Summarized Changes
5.1.1	The sentence “if a patient misses 4 or more consecutive days, the prescription must be cancelled, and the prescriber notified” has been removed.
5.1.4	The following points have been added: If a patient misses 6 or more consecutive days, without return to full opioid agonist use, the prescription must be cancelled, and the prescriber notified. If there are 5 or fewer consecutive once-daily missed doses, without return to full opioid agonist use, do not cancel. The patient can resume the previous dose of buprenorphine/naloxone. If a patient misses 4 or more consecutive days, with return to full opioid agonist use, the prescription must be cancelled, and the prescriber notified. If there are 3 or fewer consecutive once-daily missed doses, with return to full opioid agonist use, do not cancel the prescription. The patient can resume the previous dose of buprenorphine/naloxone. The pharmacist should assess the patient to determine if they are in any acute clinical condition that would put them at risk of an adverse event. The pharmacist should discuss the risks of precipitated withdrawal with the patient, if appropriate and necessary.

Principle

Summarized Changes

5.1.1

The sentence “if a patient misses 4 or more consecutive days, the prescription must be cancelled, and the prescriber notified” has been removed.

5.1.4

The following points have been added:

If a patient misses 6 or more consecutive days, without return to full opioid agonist use, the prescription must be cancelled, and the prescriber notified. If there are 5 or fewer consecutive once-daily missed doses, without return to full opioid agonist use, do not cancel. The patient can resume the previous dose of buprenorphine/naloxone.
If a patient misses 4 or more consecutive days, with return to full opioid agonist use, the prescription must be cancelled, and the prescriber notified. If there are 3 or fewer consecutive once-daily missed doses, with return to full opioid agonist use, do not cancel the prescription. The patient can resume the previous dose of buprenorphine/naloxone.
The pharmacist should assess the patient to determine if they are in any acute clinical condition that would put them at risk of an adverse event.
The pharmacist should discuss the risks of precipitated withdrawal with the patient, if appropriate and necessary.

Jun 03, 2024