Physicians who wish to prescribe buprenorphine must first meet several qualifications and obtain a waiver and identification number from the DEA.
Buprenorphine is an effective treatment for patients who are addicted to opioids and, because it can be prescribed in a take-home dose, is an attractive alternative to methadone. Physicians who wish to prescribe buprenorphine in their practice must first meet several qualifications and obtain a waiver from SAMHSA and an identification number from the DEA. This article outlines the application process and includes links to additional online resources and support.
The Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Substance Abuse Treatment (CSAT) website on the use of buprenorphine in opioid addiction treatment provides a wealth of information on the Drug Addiction Treatment Act of 2000 (DATA 2000), which “expands the clinical context of medication-assisted opioid addiction treatment by allowing qualified physicians to dispense or prescribe specifically approved Schedule III, IV, and V narcotic medications for the treatment of opioid addiction in treatment settings other than the traditional Opioid Treatment Program (ie, methadone clinic).” The site also provides information for physicians who wish to obtain the necessary qualifications and waivers that will enable them to prescribe buprenorphine in their practice.
To practice “opioid addiction therapy with approved Schedule III, IV, or V narcotics” such as buprenorphine, physicians must notify CSAT of their intent to begin dispensing or prescribing this treatment by completing a Waiver Notification Form (SMA-167) and mailing or faxing it to the Substance Abuse and Mental Health Services Administration Division of Pharmacologic Therapies (to the attention of the Opioid Treatment Waiver Program). Physicians can download a PDF version of this form or a print-friendly version from the SAMHSA website. The SMA-167 form can also be completed and submitted online.
Before the waiver is granted, applying physicians must meet one or more of the following qualifications:
DATA 2000 also requires that physicians applying for a waiver must “attest that they have the capacity to refer addiction treatment patients for appropriate counseling and other non-pharmacologic therapies.” Physicians are prohibited from providing addiction therapy with buprenorphine to more than 30 patients at any one time for one year following receipt of their waiver.
If an applying physician meets the requirements, he or she will be assigned a special identification number by the Drug Enforcement Administration (DEA) that “must be included on all buprenorphine prescriptions for opioid addiction therapy, along with the physician’s regular DEA registration number."
One year after receiving a waiver and permission to treat patients with buprenorphine for opioid addiction, physicians can apply to increase their patient limit to 100 patients. To do so, they must “submit a second notification that conveys the need and intent to treat up to 100 patients." This notification must also confirm the requestor meets all necessary qualifying criteria outlined for receiving the initial waiver. Physicians with a working e-mail address can access a form that has been pre-filled with information from their original waiver application and submit their request to increase their patient limit online. Physicians who do not have an e-mail address can either access and print out the same pre-filled form or complete a blank form and mail or fax it to the Substance Abuse and Mental Health Services Administration Division of Pharmacologic Therapies.
Physicians who have received a waiver from SAMHSA and the DEA can access this moderated, password-protected website to “ask and answer clinical questions regarding the use of buprenorphine for the treatment of opioid addiction.”
This 8-hour training is based on the experience of live training with added online features. It is designed to satisfy the training requirements of the Drug Addicition Treatment Act of 2000 for physicians to prescribe buprenorphine in office-based treatment of opioid dependent patients. The course consists of 3 video and audio/slide lectures with multiple choice tests, 3 interactive case study discussions, 4 filmed vignettes portraying situations the physician may encounter in providing this treatment, and an update information section.
This website from Clinical Tools, Inc, offers an official training program that satisfies the SAMHSA training requirement for a DATA 2000 physician waiver. The program consists of 12 courses, all of which (including a pre/post-test) must be completed to be eligible for the waiver.
Participants who complete this course may also also claim eight credit hours of AMA PRA Category 1 Credit. In addition to the training course, the website also offers a variety of useful resources for physicians who prescribe buprenorphine in their practice, including “How-To” guides that “provide clinical information and step-by-step guidance on topics related to opioid addiction and setting up and managing office-based buprenorphine treatment.” The “How to Get Started Prescribing Buprenorphine” and “How to Comply with Rules, Regulations, and Record Keeping” guides are strongly recommended. Participants can also access CME courses on motivational interviewing, instructions on creating a personalized website (called a “BupSite”) to promote and advertise their practice, patient handouts, downloadable forms, and other resources.
The AAAP site offers information on upcoming live training courses, Web-based training courses, CD-ROM versions of the training, and a “half and half” course that features “3.75 hours of on-your-own-training and 4.25 hours of face-to-face training with an instructor.” The self-directed portion of the course includes CD modules that “provide background in substance abuse treatment and specifically in treatment of opioid use disorders and use of buprenorphine.” The other half of the course requires classroom training guided by a course director “who has already obtained the waiver to practice with buprenorphine and is doing so in his/her community.” Classroom sessions “will focus on clinical vignettes to help trainees think through ‘real life’ experiences in opioid use disorders treatment and will have several ‘overview’ lectures that will provide a knowledge base necessary for this practice.”
A collaborative project of the American Academy of Addiction Psychiatry (AAAP), the American Osteopathic Academy of Addiction Medicine (AOAAM), and the American Psychiatric Association (APA), the PCSS-B is designed to “provide training and clinical mentorship to practicing physicians and physicians-in-training who wish to include office-based treatment of opioid use disorders in their practices.” In addition to several eight-hour training modules, offered in a variety of formats, the PCSS-B also provides a collection of informative tools and resources for physicians treating patients for opioid addiction. The “Hot Topics in Buprenorphine Treatment” webinar series features leading clinical experts, researchers, and government officials who address “a variety of clinical topics, as well as emerging legislative, regulatory, and practice management issues.” Physicians can also use this site to find a buprenorphine mentor (or sign up to become one themselves), access advanced case studies, download intake forms and sample treatment agreements, and review clinical guidance documents that offer evidence-based advice and information on key topics in buprenorphine treatment.
Visit this site for information and support for prescribing buprenorphine in your practice. The site offers a matching service that helps patients find qualified physicians who are able to provide buprenorphine treatment for opioid addiction, links to information about live and online buprenorphine training courses, downloadable forms and worksheets, billing information and support, and more.