Health Advisory: Updates on Buprenorphine and Controlled Substances Prescribing, Overdose Data, Naloxone, and Xylazine

Actions requested

• Be aware: the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Drug Enforcement Agency (DEA) recently announced the elimination of the requirement for prescribers to have a DATA 2000 (X) waiver to prescribe buprenorphine.
  • Effective immediately, all practitioners with a DEA registration that includes Schedule III authority can now prescribe medications for opioid use disorder as they would any other medication.
  • There are no medication-specific training requirements and no limits on the number of patients receiving prescriptions.
    
• Be aware that the DEA announced publication of two Notice of Proposed Rulemakings in the Federal Register on Feb. 24 related to expanding patient access to prescriptions for controlled substances via telemedicine encounters. The proposed rule changes are:
  • Telemedicine Prescribing of Controlled Substances When the Practitioner and the Patient Have Not Had a Prior In-Person Medical Evaluation
  • Expansion of Induction of Buprenorphine via Telemedicine Encounter (expanding the circumstances under which practitioners can prescribe schedule III-V drugs approved for maintenance treatment or withdrawal management treatment via telemedicine, including audio-only telemedicine)
     
• Be aware of state Health Care Authority resources about medications for opioid use disorder (MOUD).
  
• Be aware:
  • Preliminary Kitsap resident mortality data indicate approximately 49 drug-related deaths in 2022, similar to the number in 2021 (53). In 2022, more than half of drug-related-deaths (28 of 49) likely involved fentanyl. 
  • Emergency Medical Services (EMS) data show response to 275 possible overdoses in 2022, up from 228 in 2021 and 178 in 2020.
    
• Ensure patients have access to naloxone if they, friends or loved ones are at risk of overdose.
  • Naloxone is covered by Medicaid in Washington State.
  • Naloxone can be dispensed at pharmacies without a prescription under the statewide standing order.
  • Naloxone can be ordered by mail in Washington State.
    
• Be aware of the emergence of the drug xylazine in Washington State. Review FDA guidance to health care professionals, released in November 2022.
  • Learn more by watching a recording of the University of Washington Addictions, Drug and Alcohol Institute (ADAI) Webinar: What’s the Latest on Xylazine? (Feb 15, 12pm PT). Slides from the webinar are available here.
    
• Help to reduce the stigma of drug use. With the escalating drug crisis in our community, state and nation, reframing the way in which we think about and describe people who use drugs (PWUDs) is a key component in reducing the stigma of drug use, and the subsequent reluctance of PWUDs to accessing healthcare.
  • Reframing the language around drug use is essential to changing perceptions, as it shifts the focus of drug addiction from being a moral, social or criminal issue to a medical issue, which deserves treatment.
  • The language we use to address PWUDs can have damaging effects. Terms such as “drug abuser” and “addict” carry negative connotations. When PWUDs adopt these terms for themselves they are more likely to experience self-stigma and “accept” that they cannot recover

Contacting the health district

• Call: 360-728-2235 and leave a message. Includes reporting notifiable conditions 24 hours a day, 7 days a week. Leave the patient’s name, date of birth and disease.
• Fax: 360-813-1168.