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Feb 22 2023

Prescribing medication for addiction treatment: now with no waivers and no limits

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Recently, NCMB has received inquiries from licensees regarding changes to the prescribing of buprenorphine to patients with opioid use disorder. Here is what you need to know:

In January, the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Drug Enforcement Administration (DEA) issued guidance on the removal of the X-waiver, clearing the way for more medical professionals to treat opioid use disorder with medication. As stated in the guidance, going forward, anyone with a standard DEA registration number may prescribe buprenorphine. In addition, there are no longer any limits on the number of patients a prescriber may treat for opioid use disorder with the drug.

Note for APPs: In North Carolina advanced practice providers, including PAs, had been obligated to have a supervisor with an X-waiver in order to prescribe buprenorphine under their own waiver. Going forward, neither the APP nor the supervising physician need a waiver to prescribe buprenorphine. In accordance with North Carolina administrative rules governing PA practice, in order to prescribe buprenorphine, a PA does need to ensure that their supervising physician both holds a valid DEA registration AND is familiar with prescribing buprenorphine for opioid use disorder.

Previously, any clinician who wished to treat opioid use disorder with the prescription medication buprenorphine was required to obtain an X-waiver from SAMHSA to do so lawfully. Initially, clinicians had to complete several hours of specialized training in order to get the waiver. The federal government loosened those requirements in 2021, allowing interested clinicians to obtain a waiver without completing training, as long as they limited the number of patients treated with buprenorphine to 30. The signing of the Consolidated Appropriations Act of 2023 on Dec. 29, 2022 did away with waivers and limits entirely.

Clinicians who are interested in prescribing buprenorphine for opioid use disorder are encouraged to educate themselves to ensure they are able to meet accepted and prevailing standards of care. Learn more about prescribing buprenorphine here or by visiting NCMB’s resource page on medication for addiction treatment (MAT) at

 Comments on this article:

As a buprenorphine provider for over 20 years, these changes are welcome.

I would like to assist primary care providers who are thinking about prescribing buprenorphine—maybe the Board can facilitate linking primary care providers with volunteers for this?

By William Price on Feb 25, 2023 at 9:13am
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