1. Prescriber-Friendly Buprenorphine Delivery Model
Prescriber’s Supported Role
Formerly Prescriber’s Tasks
Appointment with Physician
Intake
Screening
Induction
Nurse, counselor, other personnel
Nurse, counselor, other personnel
Determine level of care for patient
Uniform Placement Criteria (UPC)
Nurse, counselor, or other clinician.
Observed induction using COWS
Prescriber may choose to be present for induction.
Patient meets with prescriber before induction.
Prescriber writes buprenorphine prescription for induction.
Prescribing Protocol
Behavioral
Therapy
Graduated prescribing method
1st Rx is for 24 hours
Upon certain number of clean urine screens, patient “graduates” to a longer Rx.
Run by counselors, other clinicians, or nurses.
Prescriber may attend as often as they would like.
Refill Protocol
Diversion Management
Patient attends a pre-refill visit with an SUD counselor.
Counselor makes prescribing recommendation. (Based on a set of conditions agreed upon by the prescriber; a “check list”)
Prescriber writes Rx; only sees patient if there is a problem.
Handled by counselors, nurses, or other clinicians at weekly meetings:
Observed urine screens
Wrapper or pill counts
Drug screenings

2. Prescriber-Friendly Buprenorphine Delivery Model: Greater Prescriber Involvement
Prescriber’s Supported Role
Formerly Physician’s Tasks
Appointment with Physician
Intake
Screening
Induction
Nurse, counselor, other personnel
Nurse, counselor, other personnel
Determine level of care for patient
Uniform Placement Criteria (UPC)
Nurse, counselor, or other clinician.
Observed induction using COWS
Prescriber may choose to be present for induction.
Patient meets with prescriber before induction.
Prescriber writes buprenorphine prescription for induction.
Prescribing Protocol
Behavioral
Therapy
Graduated prescribing method
1st Rx is for 24 hours
Upon certain number of clean urine screens, patient “graduates” to a longer Rx.
Run by counselors, other clinicians, or nurses.
Prescriber may attend as often as they would like.
Diversion Management
Refill Protocol
Patient attends a pre-refill visit with an SUD Counselor and Prescriber.
Prescriber writes Rx for the patient based on the Graduated Prescribing Protocol.
Handled by counselors, nurses, or other clinicians at weekly meetings:
Observed urine screens
Wrapper or pill counts
Drug screenings