A provision of the federal Controlled Substances Act (21 U.S. Code § 823(g)(2)) allows qualified physicians to request a waiver for prescribing and dispensing buprenorphine, one of three FDA-approved medication-assisted treatments (MAT). MAT combines counseling and behavior therapy with medication to provide safer, comprehensive treatment of opioid use disorders. More than 35,000 physicians have received waivers through the Substance Abuse and Mental Health Services Administration’s (SAMHSA) Buprenorphine Waiver Program. Physicians are initially limited to treating 30 patients annually, but may request an increase of up to 275 patients.
Despite these efforts, the U.S. continues to deal with high rates of opioid use disorder and an opioid overdose epidemic. To expand access to MAT, the Comprehensive Addiction and Recovery Act of 2016 allows nurse practitioners (NPs) and physician assistants (PAs) to also receive waivers and prescribe buprenorphine. To qualify for the waiver, NPs and PAs must complete 24 hours of training or be able to demonstrate their ability to treat opioid-dependent patients. The NPs and PAs must also adhere to state scope of practice laws such as laws relating to prescriptive authority and physician supervision.
Just as with physician waivers, SAMHSA reviews the qualifications of applying NPs and PAs and, if approved, grants them a waiver and assigns a special identification number through the Drug Enforcement Administration to be included on buprenorphine prescriptions. Finally, NP and PA waivers allow for a maximum of 30 patients treated annually, but do not permit increased caseloads.
The waiver program for NPs and PAs began in early 2017 and it will take some time before an evaluation of the program’s impact on MAT access and opioid dependency can occur. For more information on MAT and the Buprenorphine Waiver Program, visit SAMHSA’s website. A compendium of resources relating to substance use can be found at the SAMHSA-HRSA Center for Integrated Health Solutions’ website and opioid-use specific resources and trainings can be found at SAMHSA’s PCSS-O website.