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Submitted URL: http://buprenorphine.samhsa.gov/
Effective URL: https://www.samhsa.gov/medication-assisted-treatment/become-buprenorphine-waivered-practitioner
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Effective URL: https://www.samhsa.gov/medication-assisted-treatment/become-buprenorphine-waivered-practitioner
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BREADCRUMBS
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1. Home
2. Programs
3. Medication-Assisted Treatment (MAT)
4. Become a Buprenorphine Waivered Practitioner
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MEDICATION-ASSISTED TREATMENT
* MAT Medications, Counseling, and Related Conditions
* Find Medication-Assisted Treatment
* Become a Buprenorphine Waivered Practitioner
* NOI Buprenorphine Waiver Application
* FAQs About the Buprenorphine Waiver Program
* FAQs About the New Practice Guidelines (April 2021)
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* Buprenorphine Practitioner Resources and Information
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* Statutes, Regulations, and Guidelines
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* About SAMHSA’s Division of Pharmacologic Therapies (DPT)
PAGE TITLE
BECOME A BUPRENORPHINE WAIVERED PRACTITIONER
MAIN PAGE CONTENT
Learn how to become a buprenorphine waivered practitioner to treat opioid use
disorder (OUD).
--------------------------------------------------------------------------------
Qualified practitioners can offer buprenorphine, a medication approved by the
Food and Drug Administration (FDA), for the treatment of opioid use disorders
(OUD). The Drug Addiction Treatment Act of 2000 (DATA 2000) and the Substance
Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients
and Communities or SUPPORT for Patients and Communities Act of 2018 (SUPPORT
Act) expands the use of medication-assisted treatment using buprenorphine to
additional practitioners in various settings.
To receive a practitioner waiver to administer, dispense, and prescribe
buprenorphine practitioners must notify SAMHSA’s Center for Substance Abuse
Treatment (CSAT), Division of Pharmacologic Therapies (DPT) of their intent to
practice this form of medication-assisted treatment (MAT). The notification of
intent (NOI), or buprenorphine waiver application, must be submitted to SAMHSA
before the initial dispensing or prescribing of OUD treatment medication.
Qualified practitioners include physicians, Nurse Practitioners (NPs), Physician
Assistants (PAs), Clinical Nurse Specialists (CNSs), Certified Registered Nurse
Anesthetist (CRNAs), and Certified Nurse-Midwifes (CNMs). Apply for a
buprenorphine waiver.
Recent Practice Guidelines have allowed for an alternative NOI for those seeking
to treat up to 30 patients: The customary NOI requires eligible providers to
undertake required training activities prior to their application to prescribe
buprenorphine; the alternative type of NOI allows those providers who wish to
treat up to 30 patients to forego the training requirement, as well as
certification to counseling and other ancillary services (i.e., psychosocial
services). Practitioners utilizing this training exemption are limited to
treating no more than 30 patients at any one time (time spent practicing under
this exemption will not qualify the practitioner for a higher patient limit).
This exemption applies only to the prescription of Schedule III, IV, and V drugs
or combinations of such drugs, covered under the CSA, such as buprenorphine.
Qualified practitioners who undertake required training can treat up to 100
patients using buprenorphine for the treatment of opioid use disorder (OUD) in
the first year if they possess a waiver under 21 U.S.C. § 823(g)(2) (i.e., a
DATA 2000 waiver) and meet certain conditions.
One of two conditions must be satisfied for qualified practitioners to treat 100
patients in their first year:
1. The physician holds a board certification in addiction medicine or addiction
psychiatry by the American Board of Preventive Medicine or the American
Board of Psychiatry and Neurology
2. The practitioner provides medication-assisted treatment (MAT) in a
"qualified practice setting." A qualified practice setting is a practice
setting that:
* provides professional coverage for patient medical emergencies during
hours when the practitioner's practice is closed;
* provides access to case-management services for patients including
referral and follow-up services for programs that provide, or financially
support, the provision of services such as medical, behavioral, social,
housing, employment, educational, or other related services;
* uses health information technology systems such as electronic health
records;
* is registered for their State prescription drug monitoring program (PDMP)
where operational and in accordance with Federal and State law; and
* accepts third-party payment for costs in providing health services,
including written billing, credit, and collection policies and procedures,
or federal health benefits.
275 Waiver Criteria
After one year at the 100-patient limit, qualifying practitioners who meet the
above criteria can apply to increase their patient limit to 275. In addition, 42
CFR 8.655 defines circumstances in which qualifying practitioners may request a
temporary increase to treat up to 275 patients to address emergency situations
for six months. Apply for a buprenorphine waiver.
BUPRENORPHINE WAIVER NOTIFICATION OF INTENT (NOI)
The NOI buprenorphine waiver application contains all the data items necessary
to complete the processing of the buprenorphine waiver application. The NOI must
contain information on the practitioner’s qualifying credentials and additional
certifications. It must also confirm that the practitioner will not have more
than the approved number of patients at any one time, regardless of the number
of practice locations.
Practitioners who wish to apply for an initial waiver must upload their training
certificate after completing the buprenorphine waiver application to show that
they have completed the required training to prescribe and dispense
buprenorphine.
The recent Practice Guidelines exempts eligible physicians, physician
assistants, nurse practitioners, clinical nurse specialists, certified
registered nurse anesthetists, and certified nurse midwives from the
certification requirements related to training, counseling and other ancillary
services (i.e., psychosocial services) under 21 U.S.C. § 823(g)(2)(B)(i)-(ii) of
the Controlled Substances Act (CSA).
Practitioners utilizing this exemption are limited to treating no more than 30
patients at any one time (time spent practicing under this exemption will not
qualify the practitioner for a higher patient limit). This exemption applies
only to the prescription of Schedule III, IV, and V drugs or combinations of
such drugs, covered under the CSA, such as buprenorphine.
Complete the Online Request for a New Waiver or Patient Limit Increase.
SAMHSA reviews applications within 45 days of receipt. Once the application
process is complete and the application is approved, SAMHSA will email an
approval letter to the practitioner indicating their waiver level with
certification date, and informing them they will receive their x-designation
from the DEA within seven to ten business days.
If it has been more than 45 days since a practitioner has submitted an
application or if a practitioner submitted an application and did not receive an
acknowledgement of receipt, contact CSAT's Buprenorphine Information Center at
1-866-BUP-CSAT (1-866-287-2728) or send an email to
infobuprenorphine@samhsa.hhs.gov(link sends email).
APPLY TO BEGIN TREATMENT WITH BUPRENORPHINE IMMEDIATELY
Several federal laws and regulations permit physicians and other qualifying
practitioner to administer medications approved by the Food and Drug
Administration (FDA) for the treatment of OUD under special circumstances
without a buprenorphine waiver. Learn about these special circumstances.
To receive permission to provide treatment while a waiver notification is under
review, check the box "New Notification, with the intent to immediately
facilitate treatment of an individual (one) patient" on the waiver notification
form. Checking the “immediate” box is only one of three requirements a
practitioner must meet in order to start a patient on treatment, and immediate
treatment is limited to one patient per form submitted. Each form must have a
different submission date. Practitioners must address the additional following
requirements:
* Meet “in good faith” the criteria for obtaining a waiver such as having a
valid medical license, valid Drug Enforcement Administration (DEA)
registration, and proof of completion of 8 hours of qualified training for
physicians and 24 hours for other qualified practitioners (For those applying
for the 30 patient limit, proof of qualified training is no longer required,
but still encouraged).
* Contact CSAT's Buprenorphine Information Center at 1-866-BUP-CSAT
(1-866-287-2728) or send an email to infobuprenorphine@samhsa.hhs.gov(link
sends email) to verify that the notification form has been received and to
notify CSAT of the practitioner’s intent to begin treating one patient.
* After reviewing the practitioners immediate to treat request, CSAT’s
Buprenorphine Information Center will send an email to the practitioner
approving their intent to treat one patient immediately.
Since the practitioner will not have a unique identifying number, pharmacists
may question prescriptions received under this provision. Pharmacists should
contact CSAT's Buprenorphine Information Center for additional information at
1-866-BUP-CSAT (1-866-287-2728) or send an email to
infobuprenorphine@samhsa.hhs.gov(link sends email).
ANNUAL REPORTING REQUIREMENTS TO TREAT UP TO 275 PATIENTS
Every year, per 42 CFR 8.635, qualified practitioners approved to treat up to
275 patients must submit information about their practice to SAMHSA for purposes
of monitoring regulatory compliance. The goal of the reporting requirement is to
ensure that practitioners are providing buprenorphine treatment in compliance
with the final rule Medication Assisted Treatment for Opioid Use Disorders (81
FR 44711).
TRAINING
For those providers who wish to treat more than 30 patients after their first
year of certification, SAMHSA funds the Providers’ Clinical Support System(link
is external) (PCSS) to provide practitioner training in the evidence-based
prevention and treatment of OUD and offers the required trainings(link is
external) needed to apply for buprenorphine waiver notifications. Learn more
about practitioner buprenorphine training requirements.
* Physician Buprenorphine Waiver Training(link is external) – 8-hour training
* Nurses Buprenorphine Waiver Training(link is external) (NPs, CNSs, CRNAs,
CNMs) – 24-hour training
* Physician Assistant Buprenorphine Waiver Training(link is external) – 24-hour
training
SAMHSA offers tools, training, and technical assistance to practitioners in the
fields of mental and substance use disorders. Find information on SAMHSA
training and resources. SAMHSA has developed a Buprenorphine Quick Start Guide
(PDF | 1.4 MB) and pocket guide (PDF | 200 KB) for all practitioners seeking to
prescribe buprenorphine.
For those practitioners who wish to prescribe under the 30-patient limit,
without subsequent increases in this cap, the training requirement is no longer
required. This has been implemented to reduced barriers in access to
Buprenorphine. If a prescriber wishes to treat more than 30 individual patients
in a given year, the prescriber must submit the required training documentation
in a new Notice of Intent.
Learn more about buprenorphine. For additional information on buprenorphine
waivers, FAQs are available.
LAST UPDATED
Last Updated: 04/21/2022
MAT RR - MEDICATIONS TO TREAT OPIOID ADDICTION
MEDICATIONS TO TREAT
OPIOID ADDICTION
Methadone
Naltrexone
Buprenorphine
OPIOID TREATMENT PROGRAM DIRECTORY BANNER
MAT OPIOID OVERDOSE BANNER
MAT RR - BUPRENORPHINE WAIVER PROCESSING CONTACTS
BUPRENORPHINE WAIVER CONTACTS
For information on buprenorphine waiver, contact the SAMHSA Center for Substance
Abuse Treatment (CSAT) at 866-BUP-CSAT (866-287-2728) or
infobuprenorphine@samhsa.hhs.gov(link sends email).
MAT RR - CONTACT US
OPIOID TREATMENT PROGRAM CONTACTS
For information about other medication-assisted treatment (MAT) or the
certification of opioid treatment programs (OTPs), contact the SAMHSA Division
of Pharmacologic Therapies at 240-276-2700. DPT@SAMHSA.HHS.Gov(link sends
email).
For assistance with the Opioid Treatment Program Extranet, contact the OTP
helpdesk at OTP-Help@jbsinternational.com(link sends email) or 1-866-348-5741.
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