Buprenorphine Practice Guidelines: What You Need to Know

AAPA Shares Practical Advice for PAs

June 16, 2021

In April, the U.S. Department of Health and Human Services (HHS) announced new buprenorphine practice guidelines that exempt PAs and other qualified prescribers from federal certification requirements related to training and counseling. Here’s what you need to know about the new practice guidelines.

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Under the new guidelines, providers:

• Are exempt from requirements under the Controlled Substances Act that they undergo training and make counseling available to patients.
• Are limited to prescribing buprenorphine to a maximum of 30 patients at a time and will be required to notify the Substance Abuse and Mental Health Services Administration (SAMHSA) of their intent to prescribe the drug.
• Wishing to prescribe buprenorphine to more than 30 patients will need to meet more stringent requirements, including training, as outlined by SAMHSA.

Training and other ancillary services were a part of the process for obtaining a waiver to treat up to 30 patients with buprenorphine. The new Practice Guidelines for the Administration of Buprenorphine for Treating Opioid Use Disorder provide an exemption to the training requirement for providers treating up to 30 patients. The previous guideline that required PAs to obtain 24 hours of training before prescribing buprenorphine for substance use disorder (SUD) was often a barrier to treatment.

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“The issue can be confusing,” according to AAPA’s Vice President of Education and Research & Chief Strategy Officer, Daniel Pace, “since the training requirements for PAs have changed over the years. We want to help PAs understand the current guidelines, particularly those who may practice in primary care, have an interest in addiction medicine, or serve as a PA educator.”

PAs treating up to 30 patients
24-hour waiver training is no longer required for up to 30 patients. PAs still need to submit a notice of intent to SAMSHA. If PAs want an in-depth overview on buprenorphine – whether new to addition medicine or looking for a refresher – there is free training from the American Society of Addiction Medicine (ASAM). They can participate in modules that will be helpful for them.

PAs treating more than 30 patients
For PAs and future PAs who currently work or are interested in addiction medicine as a specialty, and may need to treat more than 30 patients, 24-hour waiver training is required, as well as the submission of an X-waiver notification. Find more information from the Society of PAs in Addiction Medicine.

PA educators and students
Since newly graduated PAs can prescribe in their practice without having to do additional training, this area needs to be thoughtfully integrated into PA program curriculums. Faculty members should be aware of the new guidelines and educate their students on the treatment of patients with SUD, as well as SAMHSA’s updated notification of intent process. For students on clinical rotations, preceptors may be more likely to prescribe buprenorphine with the updated training requirements.

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