Physician Clinical Support System (PCSS) - - - by Jennifer Brownell, ASAM

One of the more unique adjuncts to the federally mandated physician training for buprenorphine prescribing program is the Buprenorphine Physician Clinical Support System (PCSS), a national physician mentoring program. 

The PCSS has been funded by the Substance Abuse and Mental Health Services Administration (SAMHSA) since September, 2004.  The PCSS is designed to assist practicing physicians, in accordance with the Drug Addiction Treatment Act of 2000, to incorporate into their practices the treatment of prescription opioid and heroin dependent patients using buprenorphine.  The American Society of Addiction Medicine (ASAM), in consortium with other specialty addiction medicine, psychiatric, pain and general medicine societies, created the PCSS to assist physicians in the appropriate use of this medication.

The PCSS focuses on educating primary care physicians, pain specialists, psychiatrists, and other physicians who are often reluctant to treat patients dependent on heroin or other opiates. This will assist in increasing access to the millions of untreated prescription opioid- and heroin-dependent persons in the country.        

The PCSS is a national network of 70 trained physician mentors with expertise in addiction treatment and skilled in clinical education, who are supported by a PCSS medical director and by 5 physicians who are national experts in the use of buprenorphine. The physicians mentors provide services via telephone, email, and/or at the place of clinical practice to nearly 1500 clinicians providing office-based treatment with buprenorphine.  The PCSS is a free service that offers support on patient selection, induction, dosing and patient monitoring, and treatment of poly-substance dependence or co-occurring conditions. 

The PCSS Steering Committee is comprised of 23 organizations representing primary care, psychiatry, addiction medicine, pediatrics, HIV and pain medicine, osteopathic medicine, specialty treatment programs, addiction counselors, and federal and state agencies.  The PCSS Speaker’s bureau conducted presentations at over 30 state chapters of the American Academy of Family Practice or the American College of Physicians in 2006

The PCSS’s 70 mentors are located in or provide mentoring to nearly 1500 practicing physicians in all 50 states and Puerto Rico.

The most common services provided by the PCSS include information on:

  • Induction timing and procedures
  • Medication management
  • Scheduling
  • Paperwork

A number of online resources have been created and can be accessed through the website.  Here clinicians can download of self study materials such as Clinical Guidances.  Guidances currently exist on the following topics: 

  • Acute Pain
  • Management of Psychiatric Medications in Patients Receiving Buprenorphine/Naloxone
  • Monitoring of Liver Function Tests and Hepatitis in Patients Receiving Buprenorphine/Naloxone
  • Opioid Therapies, HIV Disease, and Drug Interactions
  • Physician Billing for Office-Based Treatment of Opioid Dependence
  • Pregnancy and Buprenorphine Treatment
  • Transfer from Methadone to Buprenorphine

The website ( receives a large number of visits from interested individuals and is a well accessed resource that is updated continuously.  The PCSS warm line (1-877-630-8812) provides a national system of telephone triage that registers clinicians (physicians and support staff) and matches them with an appropriate mentor within 48 hours.  The warm line fields approximately 25 inquiries a week from individuals seeking general information about buprenorphine, and provides a necessary referral service for individuals both by engaging them in the PCSS, and by directing them to the SAMHSA buprenorphine website and information service.

The PCSS list-serve provides an important source of clinical best practice information sharing and the provision of mentoring resources.  No matter how much or how little clinical experience one has with buprenorphine and office-based practice, novel situations arise frequently that prompt consultation from a colleague, mentor, or better yet, the combined wisdom of the PCSS list-serve. 

The future of the PCSS has yet to be determined.  We hope it will continue to expand in its initial mission of providing ongoing support for office-based treatment with buprenorphine.  With involvement of more participants it could grow into a more broad-based organization that spreads expertise and education about all forms of addiction treatment throughout organized medicine.  Please consider taking a few minutes to visit the PCSS website.  If you are a physician please consider becoming a participant or a mentor.



Copyright © 2007 NAABT, Inc.
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