Section 303 of the Comprehensive Addiction and Recovery Act (CARA), signed into law by President Obama on July 22, 2016, made several changes to the law regarding office-based opioid addiction treatment with buprenorphine. ASAM's complete summary of CARA is available here
One of these changes is that prescribing privileges have been expanded to nurse practitioners (NPs) and physician assistants (PAs) for five years (until October 1, 2021). The below information and resources will help members and the public understand this specific change.
Now Available: Apply for a Waiver
NPs and PAs who have completed the 24 hours of required training may seek to obtain a DATA 2000-waiver for up to 30 patients may apply by completing a hardcopy of the Notification of Intent (NOI) and sending to email@example.com, along with copies of their training certificate(s).
Starting February 27, 2017 SAMHSA will only accept electronic submissions of the NOI. These waiver applications are forwarded to the DEA, which will assign the NP or PA a special identification number. DEA regulations require this number to be included on all buprenorphine prescriptions for opioid dependency treatment, along with the NP’s or PA’s regular DEA registration number.
SAMHSA shall review waiver applications within 45 days of receipt. If approved, NPs and PAs will receive a letter via email that confirms their waiver and includes their prescribing identification number.
To be redirected to SAMHSA's website, click here.
On November 17, 2016, the Department of Health and Human Services (HHS) announced that NPs and PAs can immediately begin taking the 24 hours of required training to prescribe buprenorphine for opioid use disorder (please see below for more information on training). NPs and PAs who complete the required training and seek to prescribe buprenorphine for up to 30 patients will be able to apply to do so beginning in early 2017. Once NPs and PAs receive their waiver they can begin prescribing buprenorphine immediately. Any NP or PA who begins to prescribe buprenorphine before applying for and receiving a waiver will be in violation of federal law.
HHS is also announcing its intent to initiate rulemaking to allow NPs and PAs who have prescribed at the 30 patient limit for one year, to apply for a waiver to prescribe buprenorphine for up to 100 patients.
For NPs and PAs to be eligible to apply for a buprenorphine waiver, they must complete 24 hours of training that covers the following topics: opioid maintenance and detoxification; clinical use of all FDA-approved drugs for medication-assisted treatment; patient assessment; treatment planning; psychosocial services; staff roles; and diversion control.
To qualify, NPs and PAs must:
• Be licensed under state law to prescribe Schedule III, IV, or V medications for pain
• Complete not less than 24 hours of appropriate education through a qualified provider
• Through other training or experience, demonstrate the ability to treat and manage Opioid Use Disorder
• If required by state law, be supervised or work in collaboration with a qualifying physician (physician must be waivered) to prescribe medications for the treatment of OUD
Please ensure that your state regulations allow you to prescribe buprenorphine and other medications to treat OUD before you apply for the waiver. Some states may have overriding state legislation that will prevent NPs from prescribing these medications even if Federal law allows it. Nurse practice laws and regulations are specific to each state. AANP has created an interactive map to provide licensure and regulatory requirements, as well as practice environment details, for all 50 states and the U.S. Territories. AANP also has a list of state practice laws and regulations categorized by type.
NPs and PAs can begin the training immediately by taking the 8-hour buprenorphine courses offered by ASAM or that other stakeholders offer. The remaining 16 hours will have to be completed with one training provider. ASAM is in the process of developing multiple 16-hour training course options and formats, including collaborations with:
Other providers that can provide the 16 hours of additional training are the American Academy of Addiction Psychiatry, American Medical Association, American Osteopathic Association, American Nurses Credentialing Center, American Psychiatric Association, American Association of Nurse Practitioners, and American Academy of Physician Assistants.
SAMHSA opened a comment period on the 24 hours of training required for Nurse Practitioners and Physician Assistants to be able to apply for a buprenorphine waiver. On behalf of our membership, ASAM submitted these written comments on implementing this training requirement.