Resources

Buprenorphine Waiver Management

Physician Qualifications

SAMHSA handles the application process for practitioners who want to prescribe buprenorphine for opioid addiction treatment. A DEA Controlled Substances Registration is required to apply. Additionally, unless a physician holds the appropriate board certifications, an 8-hour training course is required to qualify for the waiver. Once a physician has either taken the required training or received the appropriate board certification, they may apply for a waiver to begin treating 30 patients with buprenorphine. Certain practitioners may immediately begin treating up to 100 patients if they hold certain board certifications, or if they provide medications for the treatment of opioid use disorder in a qualified practice setting.

  • Learn about ASAM's Treatment of OUD Courses here!

Other Qualified Practitioner Qualifications

For nurse practitioners (NPs), physician assistants (PAs), certified nurse certified nurse specialists (CNSs), certified registered nurse anesthetist (CRNAs), and certified nurse midwives (CNMs) 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. Once a practitioner has taken the required training course and complied with other requirements listed below, they may apply for a waiver to begin treating 30 patients with buprenorphine. Certain practitioners may immediately begin treating up to 100 patients if they provide medications for the treatment of opioid use disorder in a qualified practice setting. It is important to note that CNSs, CRNAs, and CNMs are able to prescribe buprenorphine to treat OUD until October 1, 2023. 

To qualify, NPs, PAs, CNSs, CRNAs, and CNMs 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 physicians 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, PAs, CNSs, CRNAs, and CNMs can begin the training immediately by taking the 8-hour buprenorphine courses offered by ASAM or other stakeholders. 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. 

Application Form

Once you have determined that you are qualified to apply for a waiver to prescribe buprenorphine, you may do so here.

Practitioners who have had a waiver to treat 30 patients for at least one year may apply to increase their patient limit to 100. After one year at the 100-patient limit, physicians and qualifying other practitioners who meet certain criteria can apply to increase their patient limit to 275. Click here to access the application for a higher patient limit. SAMHSA will review applications within 45 days of receipt and will notify the applicant if they have been approved. DO NOT begin prescribing to the higher limit until you are approved.  

Additional resources:

Practitioners who have been approved for a 275 patient limit must adhere to strict annual reporting requirements. The report is normally due before the anniversary of your waiver approval date.

If your annual report is not received by SAMHSA by the required date, your 275 patient prescribing authority will be automatically rescinded and your patient limit will return to 100 as previously authorized. Additionally, all patients under your care beyond the 100 patient limit will need to be notified of your reduced patient capacity and directed to alternative resources for treatment.

The SAMHSA 275 Annual Report Form details all of the requirements necessary to complete and submit the form.  

Physicians who plan to apply for a patient increase to 275 must follow several requirements and standards. Two of these requirements are to practice according to nationally recognized evidence-based guidelines and have a diversion control plan. The below resources will help you abide by these two requirements.
  • Nationally Recognized Evidence-Based Guidelines
    • ASAM's National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use. You can find information on ASAM's guideline here!
    • SAMHSA's Treatment Improvement Protocol 40: Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction, available here.
    • The World Health Organization Guidelines for the Psychosocially Assisted Pharmacological Treatment of Opioid Dependence, available here.
    • The Department of Veterans Affairs /Department of Defense/ Clinical Practice Guideline on Management of Substance Use Disorder, available here.
    • The Federation of State Medical Boards’ Model Policy on DATA 2000 and Treatment of Opioid Addiction in the Medical Office, available here.
  • Diversion Control Plan 
  • Confidentiality
    • Federal regulation requires physicians who apply to provide appropriate releases of information, in accordance with federal and state laws and regulations, including 42 CFR Part 2, to permit the coordination of care with behavioral health, medical and other service practitioners. ASAM has created a sample form in order to assist physicians with this requirement.
  • FAQ