The U.S. Department of Health and Human Services (HHS) is taking additional steps to address the U.S. opioid epidemic by further expanding access to medication-assisted treatment (MAT) for opioid use disorders. 

Administered by the Substance Abuse and Mental Health Services Administration (SAMHSA), today’s announcement enables nurse practitioners (NPs) and physician assistants (PAs) to immediately begin taking the 24 hours of required training to prescribe the opioid use disorder treatment, buprenorphine.

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. Previously, only physicians could prescribe buprenorphine.  Once NPs and PAs receive their waiver they can begin prescribing buprenorphine immediately.

“Today’s action will provide even more access to medication-assisted treatment,” said SAMHSA Principal Deputy Administrator Enomoto.  “Allowing nurse practitioners and physician assistants to prescribe buprenorphine will greatly expand access to quality, evidence-based treatment methods for those most in need of assistance.”

HHS also is 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.

HHS hosted a public meeting on October 1, 2016 on the training requirements associated with recent legislative action to expand eligible buprenorphine providers.

All training will be available either at no cost through the SAMHSA-funded Provider’s Clinical Support System - Medication Assisted Treatment program or through training programs that may be offered by the American Society of Addiction Medicine, 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 is working quickly with training providers to help them adapt curricula and obtain continuing education credits for this important training.   Updates on training information and the waiver application will be available at http://www.samhsa.gov/medication-assisted-treatment.

SAMHSA finalized a rule in July that expanded access to MAT by allowing practitioners who had a waiver to prescribe buprenorphine for up to 100 patients for a year or more, to now obtain a waiver to treat up to 275 patients.  Practitioners are eligible to obtain the waiver if they have additional credentialing in addiction medicine or addiction psychiatry from a specialty medical board and/or professional society, or practice in a qualified setting as described in the rule.  Since the rule was finalized, 2,477 practitioners have applied for and been granted a waiver to prescribe buprenorphine at the increased limit.

The HHS Opioid Initiative is focused on improving opioid prescribing practices; expanding access to medication-assisted treatment (MAT) for opioid use disorder; and increasing the use of naloxone to reverse opioid overdoses. The initiative concentrates on evidence-based strategies that can have the most significant impact on the crisis. But additional funding is necessary to ensure that every American who wants to get treatment for opioid use disorder will have access. Under the President’s FY 2017 Budget proposal, states would be eligible for up to $920 million over two years to expand access to treatment. At this time, Congress has not fully funded the budget proposal. See here for a state by state breakdown of the President’s budget and, if fully funded, the impact it would have on states’ ability to further expand access to treatment.