Buprenorphine is an opioid partial agonist that is effective for many in the treatment of opioid use disorder (OUD). Similarly to methadone, buprenorphine is a controlled substance and has the potential for misuse and diversion. However, unlike methadone, it is less likely to lead to overdose unless combined with other sedatives.
Buprenorphine can be prescribed in Opioid Treatment Programs or in a primary care provider’s medical office by a healthcare provider who has completed the required waiver course according to their profession (an 8-hour waiver training for physicians and a 24-hour waiver training for PAs and Advanced Practice Nurses – i.e. qualifying practitioners) and is certified by SAMHSA to prescribe. Waiver trainings are available to medical providers at no cost, funded by the PCSS grant. Learn more about how to access free waiver trainings offered by PCSS.
Qualifying practitioners include physicians, nurse practitioners and physician assistants. Additionally, under the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) Act, qualifying practitioners such as clinical nurse specialists, certified registered nurse anesthetists, and certified nurse midwives can prescribe buprenorphine in office-based settings until October 1, 2023 – see H.R.6 legislation.
Qualifying practitioners can treat up to 100 patients using buprenorphine for the treatment of 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 requirements.
After one year at the 100-patient limit, qualifying practitioners who meet certain 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.