Buprenorphine Prescribing Guidelines

Federal Requirements for Prescribing

Physicians with a Drug Addiction Treatment Act (DATA) waiver can prescribe buprenorphine to treat opioid use disorder, with initial patient caps of 30 in year 1, expandable to 100 in year 2, and up to 275 with additional qualifications 1, 2, 3
Physicians must obtain a federal waiver (X-waiver) from SAMHSA after completing an 8-hour training course on proper buprenorphine prescribing 1, 2, 3, 4
Waivered physicians can treat up to 30 patients with buprenorphine in the first year 1, 2, 3
After year 1, physicians may increase their patient cap to 100 patients 1, 2, 3
Qualified physicians with sufficient training and experience can treat up to 275 patients 1, 2, 3, 5

Any DEA-licensed physician without a waiver can administer (but NOT prescribe) buprenorphine in emergency departments for up to 72 hours while arranging referral 4, 6, 7
Specific restrictions include: not more than one day's medication may be administered at one time, treatment cannot exceed 72 hours, and the 72-hour period cannot be renewed or extended 4, 6, 7

Federal law permits NPs and PAs to obtain waivers to prescribe buprenorphine, but this is subject to state-specific regulations 5
The 2016 federal budget proposal supported pilot projects for NPs and PAs to prescribe buprenorphine where permitted by state law 5

Less than 4% of prescribers had obtained waivers as of 2016 (just over 37,000 physicians) 1, 2, 3
Cited barriers include lack of institutional support, insufficient mental health/psychosocial support, time constraints, lack of specialty backup, and resistance from practice partners 1, 2, 3

Methadone for opioid use disorder can only be dispensed through federally licensed opioid treatment programs, not in office-based settings 1, 4, 6, 7
Like buprenorphine, methadone can be administered (not prescribed) for up to 72 hours in emergency settings without program enrollment 4, 6, 7