To the Editor:
Thank you for publishing the review of opioid dependence management by Bouchard, Faistl, and Monaco (“Current options in the management of opioid dependence: a review,” May 2011 Review Article). It is a well-written and timely article. However, one statement regarding buprenorphine prescribing warrants clarification. The authors state:
"However, nonphysician providers such as PAs are not eligible for this specialized credential and are therefore not authorized to prescribe buprenorphine."
The assumption that PAs cannot prescribe buprenorphine is a common but incorrect interpretation of the law. Buprenorphine is FDA-indicated for opiate withdrawal, and PAs are not authorized to prescribe buprenorphine for opioid withdrawal. However, any PA with a Drug Enforcement Association (DEA) license authorizing schedule III prescribing may lawfully prescribe buprenorphine "off label" for pain management. The prescription must state "FOR PAIN MANAGEMENT ONLY." Technically, a PA may legally prescribe buprenorphine to a patient experiencing opiate withdrawal for pain management.
While this use of buprenorphine is within the law, it is too close a parsing for me and other PAs who are wary of the mystery and alarm surrounding the drug and thus develop a therapeutic nihilism and aversion to prescribing it. Regardless, PAs should not hold the idea that only physicians may prescribe it. This simply isn't true.
I continue to enjoy JAAPA. Keep up the good work.
Kindest regards,
Keir Todd, PA-C, M.Ed.