From the Guidelines
To prescribe buprenorphine for opioid use disorder, physicians must complete an 8-hour training program and obtain a special waiver from the Drug Enforcement Administration (DEA). This training, often called the "X-waiver" training, covers topics such as addiction pharmacology, patient assessment, and clinical use of buprenorphine, as outlined in the clinical policy for opioids in adult patients presenting to the emergency department 1. The training requirement exists because buprenorphine is a partial opioid agonist that requires specific knowledge for safe and effective prescribing. It helps prevent precipitated withdrawal and manages cravings while having a ceiling effect on respiratory depression, making it safer than full opioid agonists.
Key Points to Consider
- The 8-hour training program is mandatory for physicians to prescribe buprenorphine for opioid use disorder, as stated in the Drug Addiction Treatment Act of 2000 1.
- The training covers essential topics such as addiction pharmacology, patient assessment, and clinical use of buprenorphine.
- Physicians must apply for the waiver by submitting their training certificate to the DEA and receiving a special identification number that must be included on all buprenorphine prescriptions.
- The CDC guideline for prescribing opioids for chronic pain also recommends offering or arranging evidence-based treatment, usually medication-assisted treatment with buprenorphine or methadone in combination with behavioral therapies, for patients with opioid use disorder 1.
Exceptions and Considerations
- Some exemptions have been created allowing physicians to treat limited numbers of patients without the full training, but most prescribers still complete the full certification process to treat larger patient populations.
- Physicians prescribing opioids in communities without sufficient treatment capacity for opioid use disorder should strongly consider obtaining a waiver from the Substance Abuse and Mental Health Services Administration (SAMHSA) that allows them to prescribe buprenorphine to treat patients with opioid use disorder 1.
From the FDA Drug Label
• Buprenorphine hydrochloride should be prescribed only by healthcare professionals who are knowledgeable about the use of opioids and how to mitigate the associated risks. The FDA drug label does not answer the question.
From the Research
Training Requirements for Buprenorphine Prescription
- The provided studies do not directly address the amount of training a physician must complete to be certified to prescribe buprenorphine 2, 3, 4, 5.
- However, one study mentions that nurse practitioners are required to complete 16 additional hours of training on controlled substance prescribing before a buprenorphine waiver application 6.
- It is worth noting that the training requirements for physicians may be different from those for nurse practitioners, but the exact requirements are not specified in the provided studies.
- The studies focus more on the effectiveness of buprenorphine treatment, behavioral counseling, and the impact of regulatory mandates on prescribing practices, rather than the specific training requirements for physicians 2, 3, 6, 4, 5.