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This document is a notification form developed by the Substance Abuse and Mental Health Services Administration (SAMHSA) for practitioners to apply for waivers to prescribe specific narcotic drugs

How to fill out notification of intent to

How to fill out Notification of Intent To Use Schedule III, IV, or V Opioid Drugs for the Maintenance and Detoxification Treatment of Opiate Addiction

1. Obtain the Notification of Intent form from the relevant regulatory authority.
2. Fill in the practitioner’s information, including name, address, and contact details.
3. Provide the name and NPI (National Provider Identifier) of the practice location.
4. Indicate the specific Schedule III, IV, or V opioid drugs intended for use in treatment.
5. Detail the proposed treatment plan, including dosage and duration.
6. Include any relevant patient eligibility criteria.
7. Attach any required documentation, such as certifications or treatment protocols.
8. Review the completed form for accuracy and completeness.
9. Submit the form to the appropriate state or federal agency as instructed.

Who needs Notification of Intent To Use Schedule III, IV, or V Opioid Drugs for the Maintenance and Detoxification Treatment of Opiate Addiction?

1. Medical practitioners intending to provide maintenance or detoxification treatment for opiate addiction using Schedule III, IV, or V opioids.
2. Facilities that provide addiction treatment services and require compliance with regulatory standards.
3. Any healthcare provider involved in prescribing opioid medications for the treatment of substance use disorders.

People Also Ask about

Which of the following drugs is used in opioid maintenance therapy?

Currently, there are three types of medications approved by the U.S. Food and Drug Administration (FDA) to treat opioid use disorder: Buprenorphine. Methadone. Extended-release injectable naltrexone.

What are the 8 opioid drugs?

“Opioids” include prescription drugs such as codeine, morphine, oxycodone (OxyContin®, Percodan®, Percocet®), hydrocodone (Vicodin®, Lortab®, Lorcet®), and meperidine (Demerol®), as well as illegal drugs like .

What medications are used in MAT?

Common prescription opioid drugs include: Hydrocodone (such as Vicodin®, Norco®) Oxycodone (such as OxyContin®, Percocet®) Morphine (such as MS Contin®, Kadian®)

Which medication is commonly used in opioid substitution and maintenance therapy?

Whilst methadone is the most common treatment option, the second is buprenorphine with naloxone, and alternate opioids are occasionally used, such as morphine, or codeine. OST is highly regulated and each daily dose is managed ingly. All patients OST prescribing is authorised by a gazetted treatment service.

What is opioid use disorder in the United States?

Symptoms of this disease include an overpowering desire to use opioids, increased opioid tolerance, and withdrawal syndrome when opioids are discontinued. Thus, OUD can range from dependence on opioids to addiction. [1] OUD affects over 16 million people worldwide and over 2.1 million in the United States.

What drugs are used for opioid therapy?

Which medicines treat opioid opioid use disorder (OUD)? The medicines used in MOUD are methadone, buprenorphine, and naltrexone: Methadone, buprenorphine, and lofexidine, which can decrease withdrawal symptoms and cravings. They work by acting on one or another of the targets in the brain that opioids act on.

What is the opioid addiction drug used in maintenance therapy?

The most common medications used in the treatment of opioid addiction are methadone, buprenorphine and naltrexone. Counseling is recommended with the use of each of these medications. Each medication works in a different way and has its own risks and benefits.

For pdfFiller’s FAQs

What is Notification of Intent To Use Schedule III, IV, or V Opioid Drugs for the Maintenance and Detoxification Treatment of Opiate Addiction?

It is a formal document that healthcare providers submit to regulatory agencies to notify them of their intention to prescribe Schedule III, IV, or V opioid drugs for the purpose of treating individuals with opiate addiction through maintenance and detoxification therapies.

Who is required to file Notification of Intent To Use Schedule III, IV, or V Opioid Drugs for the Maintenance and Detoxification Treatment of Opiate Addiction?

Healthcare providers, such as physicians or certified nurse practitioners, who intend to prescribe these specific opioid drugs for the treatment of opiate addiction must file this notification.

How to fill out Notification of Intent To Use Schedule III, IV, or V Opioid Drugs for the Maintenance and Detoxification Treatment of Opiate Addiction?

To fill out the notification, providers must complete a specific form provided by the regulatory agency, which typically requires details such as the provider's credentials, the intended treatment protocol, patient eligibility criteria, and any additional information required by law.

What is the purpose of Notification of Intent To Use Schedule III, IV, or V Opioid Drugs for the Maintenance and Detoxification Treatment of Opiate Addiction?

The purpose is to ensure compliance with regulations regarding the use of controlled substances in opiate addiction treatment, to promote accountability, and to monitor the prescribing patterns of opioid medications to prevent abuse.

What information must be reported on Notification of Intent To Use Schedule III, IV, or V Opioid Drugs for the Maintenance and Detoxification Treatment of Opiate Addiction?

The information reported typically includes the prescriber's identification details, the specific opioid drugs to be used, the treatment plan, patient information (if applicable), and any measures taken to ensure responsible prescribing.