Management of Opioid Use Disorder: See Practice Guideline 900.5034

Buprenorphine Patch (Butrans) is NON-formulary as of 2017

Subcutaneous buprenorphine extended‐release:

        WARNING: RISK OF SERIOUS HARM OR DEATH WITH INTRAVENOUS ADMINISTRATION; SUBLOCADE and BRIXADI RISK EVALUATION AND MITIGATION STRATEGY (REMS)

• Serious harm or death could result if administered intravenously. BRIXADI and SUBLOCADE form a gel or solid upon contact with body fluids and may cause occlusion, local tissue damage, and thrombo-embolic events, including life-threatening pulmonary emboli, if administered intravenously.
• Because of the risk of serious harm or death that could result from intravenous self-administration, BRIXADI and SUBLOCADE are only available through a restricted program called REMS. Healthcare settings and pharmacies that order and dispense BRIXADI and SUBLOCADE must be certified in this program and comply with the REMS requirements. 

• • SUBLOCADE® is Restricted as below:
    • Ambulatory:  For clinics (typically primary care, Pain Clinics and Project Nurture); due to REMS program, only to be filled through Legacy Apothecary. 
    • Inpatient: Non-formulary

• • BRIXADI® is Formulary Restricted as below:
    • Weekly Formulation is limited to outpatient clinics, PES (Psychiatric Emergency Services), and ESUDS (Emergency Substance Use Disorder Service), and LEMC Inpatient Pilot Program.
    • Monthly formulation will be limited to outpatient clinics and LEMC Inpatient Pilot Program
    • Planned transition to sublingual buprenorphine during inpatient stays.
    • Unity REMS education: review, educational presentation, and flyer for more details
    • LEMC Inpatient Pilot Program:
      • LEMC Pharmacists must complete the required E+ training prior to dispensing: Pharmacy.Standard Operating Procedures for Dispensing Subcutaneous Buprenorphine Extended-Release (Brixadi) for Adult Inpatient Pilot Program at Legacy Emanuel Medical Center - SLM
      • Standard Operating Procedures: REMS Buprenorphine (Brixadi) Inpatient Dispensing 
      • SBAR: REMS Buprenorphine (Brixadi) Pharmacist Workflow
    • See Brixadi REMS Fact Sheet and Website

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