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After the X-Waiver

Learn about the new guidelines practitioners must meet to prescribe buprenorphine for opioid use disorder after the elimination of the X-Waiver program.

Ophelia team
After the X-Waiver
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Fact checked by
Erica Lyons, DNP, MS, APRN, FNP-BC

Starting in 2000, the Drug Enforcement Administration (DEA) oversaw the X-Waiver program, which permitted medical professionals to prescribe buprenorphine to patients struggling with opioid use disorder. But now, more than 20 years later, the X-Waiver program has been eliminated. As part of the Consolidated Appropriations Act of 2023 and the Mainstreaming Addiction Treatment (MAT) Act, the X-Waiver is no longer needed. This legislation was signed by President Joe Biden in December 2022 and was enacted in January 2023. 

With this change, clinicians and patients alike may be left wondering about its impact on medication-assisted treatment (MAT) for opioid use disorder (OUD). If the Suboxone® waiver is no longer needed, what happens next? Here’s what we know about the new guidelines practitioners must meet to prescribe buprenorphine and how this change affects patients. 

New guidelines for practitioners prescribing buprenorphine

Under the new guidelines, practitioners who have current DEA registration with Schedule III authority can prescribe buprenorphine to treat OUD. However, they are still subject to state laws and can only do so if prescribing buprenorphine is permitted in the state where they practice. The MAT Act does not affect state laws or regulations. 

All DEA-registered practitioners (unless exempted, see Group 1 below) must now meet a new eight-hour training requirement on substance use disorder treatment and management according to the Consolidated Appropriations Act of 2023. Starting June 27, 2023, they must meet this training requirement before the date of their next scheduled DEA registration submission, whether it’s their first registration or a registration renewal. Practitioners will check a box on their DEA registration form to indicate that they successfully completed this new training requirement. As this is a one-time training requirement, practitioners will not need to address it again on future renewals. 

Originally, the DEA X-Waiver program required non-physician medical professionals to undergo 24 hours of training to prescribe buprenorphine for OUD. The American Academy of Physician Assistants (AAPA) did not support this training requirement and was part of the effort to convince Congress to establish the new uniform eight-hour requirement. 

Completing the 8-hour training requirement

Two groups of practitioners have already satisfied their requirement as part of their schooling or board certification, as outlined below. Additionally, providers with recorded X-waiver training and other previous training on the treatment and management of patients with substance use disorders will count toward fulfilling the new requirement. 

Group 1

Practitioners who received board certification in addiction medicine or addiction psychiatry from the American Board of Addiction Medicine, the American Osteopathic Association, or the American Board of Medical Specialties.

Group 2

Practitioners who graduated in good standing within the last five years of June 27, 2023, from a medical, advanced practice nursing, dental, or physician assistant school in the United States. During their schooling, they must have completed at least eight hours of training on treating and managing substance use disorders, including specific training on the appropriate clinical use of FDA-approved drugs for treating such disorders.

How will the new training work?

Practitioners don’t need to complete all the training in one session. They can complete multiple sessions as long as they reach 8 hours in total. These training sessions can be in the form of virtual offerings, classes in classroom settings, or seminars. 

Those who have not already satisfied the requirements may receive their training from any of many different accredited groups, including:

  • The American Medical Association (AMA)
  • The American Association of Nurse Practitioners (AANP)
  • The American Academy of Physician Associates (AAPA)
  • The American Society of Addiction Medicine (ASAM)
  • The American Dental Association (ADA)
  • The American Osteopathic Association 
  • Any organization that has received accreditation from the Accreditation Council for Continuing Medical Education (AACCME) or the Commission for Continuing Education Provider Recognition (CCEPR)
  • Any organization approved by the AACCME, CCEPR, or the Assistant Secretary for Mental Health and Substance Use

Ophelia’s support for clinicians

Our team here at Ophelia welcomed the news that the X-Waiver is no longer required. The X-Waiver requirement contributed to shortages of clinicians who could prescribe Suboxone, restricting access to MAT for OUD. After France removed regulations limiting buprenorphine prescriptions, fatal opioid overdoses fell 79% over the next three years. That data has led researchers to estimate that the new guidelines in the United States could lead to 30,000 fewer deaths annually from opioid overdoses—but only if there is a truly massive increase in the number of people treated with evidence-based medication such as buprenorphine.

To help clinicians meet the new training requirements, Ophelia offers an eight-hour live-virtual Buprenorphine Training program. Going through this program will satisfy the training requirements in place as of June 27, 2023, for all DEA-registered practitioners. 

Providing this training is just one of the ways Ophelia supports clinicians so they can, in turn, offer their support to patients dealing with OUD or other substance use disorders. There’s more work to be done to counter the stigma and limited access to experienced addiction experts that prevent clinicians from prescribing buprenorphine. As we continue to break down these barriers, more people with substance use disorders will be able to access life-changing care.


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