Practice Guidelines for the Administration of Buprenorphine for Treating Opioid Use Disorder

On April 28, 2021 HHS published updated Practice Guidelines for the Administration of Buprenorphine for Treating Opioid Use Disorder (OUD) that became effective immediately. These new guidelines allow for practitioners to prescribe buprenorphine for the treatment of OUD to up to 30 patients without requiring a Drug Addiction Treatment Act of 2000 waiver (DATA-waiver). The guidelines lay out the following criteria:

  1. Practitioners (defined as NPs, physicians, certified nurse-midwives, clinical nurse specialists, certified registered nurse anesthetists and PAs) may become exempt from the federal statutory training, counseling and other ancillary services requirements of prescribing buprenorphine for the treatment of OUD if they file a Notice of Intent (NOI) with the Drug Enforcement Administration (DEA) and select a patient limit of 30 on the NOI.
  2. Practitioners must be state-licensed and DEA registered.
  3. The guidelines only apply to practitioners treating up to 30 patients at one time with buprenorphine for OUD. Time spent practicing under this exemption will not qualify a practitioner to apply for a higher patient limit.
  4. The guidelines amend the requirement that if an NP (or other APRN or PA) practices in a state with a collaborative agreement requirement, the collaborating physician must be medication-assisted treatment (MAT)-qualified. Under these guidelines, the collaborating physician just needs to be DEA-registered.
  5. Practitioners who would like to treat more than 30 patients with buprenorphine for OUD must go through the normal DATA-waiver process. In this instance, if an NP is practicing in a state with a collaborative agreement requirement, their collaborating physician must be MAT-qualified for the NP to obtain a DATA-waiver and increase their patient limit.
  6. The guidelines only apply to schedule III, IV or V drugs, such as buprenorphine. They do not include methadone.
  7. Practitioners may only treat patients in a state in which they are licensed unless they are an employee of the federal government (or contractor) practicing within the scope of their employment.

Additionally, the guidelines provide the following recommendations on training, education and psychosocial treatment:

  1. Encourage practitioners practicing under this waiver to utilize the HHS Buprenorphine Quick Start Guide.
  2. Encourage practitioners practicing under this waiver to provide psychosocial services, such as counseling, to their patients.
  3. Encourage educational and training programs to develop and implement substance use disorder education and training in their core curriculum.

It is important to note that the above guidelines only apply to a patient limit of 30 patients. Practitioners who would like to treat more than 30 patients for OUD using buprenorphine must still apply for a DATA-waiver through the current process. Additional resources on MAT for opioid use disorder can be found below and NPs should be familiar with any added state based prescribing requirements as these federal changes will not supersede state law:

For additional information, please contact the AANP Government Affairs Office at 703-740-2529 or governmentaffairs@aanp.org.

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