The ability to prescribe medications to treat opioid use disorder is a core component of medication-assisted treatment (MAT). Practices should encourage and support physicians, physician’s assistants (PAs), and nurse practitioners (NPs) to take the required training and apply for waivers to prescribe buprenorphine. They should gather necessary resources and provide training to staff members on how to prescribe medications to treat opioid use disorder and support these patients.
All qualified physicians, NPs, and PAs have completed mandatory training and received their Drug Enforcement Administration (DEA) waiver to allow them to prescribe buprenorphine to treat opioid use disorder. All of these providers have a thorough understanding of MAT benefits, addiction, and recovery.
How Do You Do It?
Find and Complete a DATA-Waiver Training
For Physicians. The Drug Addiction Treatment Act of 2000 (DATA 2000) requires qualified physicians to obtain a waiver to prescribe and dispense buprenorphine in office-based settings. To be considered “qualified,” physicians must be:
- Licensed under State law,
- Registered with the DEA to dispense controlled substances,
- Capable of referring patients to counseling and other services, and
- Qualified by training or certification.
To meet the training or certification requirements, physicians can either (1) hold a board certification in addiction psychiatry or addiction medicine or (2) complete 8 hours of training on the treatment and management of patients with opioid use disorders. These DATA-waiver trainings are offered by various organizations, including the:
- American Academy of Addiction Psychiatry (AAAP),
- American Society of Addiction Medicine (ASAM), and
- Providers Clinical Support System (PCSS).
For NPs and PAs. In 2016, the Comprehensive Addiction and Recovery Act (CARA) extended the ability to prescribe buprenorphine in office-based settings to qualified NPs and PAs. These providers are required to complete 24 hours of training to be eligible for a buprenorphine waiver, 8 of which may be the DATA-waiver course for the treatment of opioid use disorder taken by physicians. PCSS and ASAM also offer the 24-hour waiver training for NPs and PAs.
Apply for a Buprenorphine Waiver
After providers complete the required training, they need to notify the Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Substance Abuse Treatment of their intent to offer MAT by submitting a Waiver Notification Form. SAMHSA provides complete directions on how to apply for a waiver. Some training programs, such as PCSS, will also describe the process to obtain a buprenorphine waiver and provide ongoing support and instructions to providers.
After SAMHSA receives the Waiver Notification Form, the Agency will review it and verify that the provider meets all qualifications. Then, the application will be forwarded to the DEA, which will assign the provider a special identification number that will be used on all buprenorphine prescriptions. SAMHSA reviews all applications within 45 days of receipt.
Within the first year of obtaining their waiver, providers are not allowed to treat more than 30 patients at a time. After 1 year, they may apply to increase patient limits for buprenorphine treatment to 100 patients with opioid use disorder. Providers who have been prescribing buprenorphine to 100 patients for at least 1 year can apply to increase their patient limits again to 275.
States may have additional requirements or regulations related to who may prescribe medications to treat opioid use disorder, particularly regarding NPs and PAs. Providers should review any State-specific regulations and work to comply with these requirements.
Seek Training on Naltrexone
While a DATA 2000 waiver is not needed for the prescription of naltrexone, it is important that providers educate themselves about the medication before using it with patients. SAMHSA’s Treatment Improvement Protocol (TIP) 63: Medications for Opioid Use Disorder includes a detailed section on the use of naltrexone. The ASAM National Practice Guideline (PDF—1 MB) also provides guidance and information on naltrexone, including formulations of naltrexone, patient selection and treatment goals, and course of treatment. Other opportunities are available to learn more about naltrexone and ask experts questions, such as webinars from PCSS, teleECHO programs, or the American Psychiatric Association’s State Targeted Response Learning Collaboratives.
What Not To Do
- Don’t start prescribing buprenorphine until you complete the required amount of training, obtain your waiver, and develop a thorough understanding of proper treatment practices.
Provides greater detail about the qualifications required and process to apply for a buprenorphine waiver.
Treatment Improvement Protocol (TIP) 63: Medications for Opioid Use Disorders. Part 2: Addressing Opioid Use Disorder in General Medical Settings
Guidelines for providers to identify, assess, and treat or refer patients with opioid use disorder.
The ASAM National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use
Lists online and in-person X-Waiver Trainings for physicians, advanced practice registered nurses (NP/CNM/CNS/CRNA), physician assistants, and medical students and provides an overview of the medications for opioid use disorder (MOUD).