Does a Family Nurse Practitioner (FNP) need a special license to prescribe Butrans (buprenorphine) in their state?

Buprenorphine Prescribing Requirements for Family Nurse Practitioners

As of 2023, FNPs no longer need a special federal waiver (X-waiver) to prescribe Butrans or any buprenorphine formulation, but they must still comply with state-specific scope of practice laws and any additional state-level supervision requirements that may restrict their prescribing authority. 1

Federal Requirements (Updated 2023)

The regulatory landscape for buprenorphine prescribing changed dramatically in 2023:

• The 2023 Consolidated Appropriations Act eliminated the federal X-waiver requirement that previously mandated an 8-hour training course and special DEA registration for prescribing buprenorphine for opioid use disorder 1
• Prior to 2023, NPs were required to complete 24 hours of training and obtain a federal waiver to prescribe buprenorphine 2
• Any DEA-licensed NP can now prescribe buprenorphine without additional federal certification, though new and renewing DEA registrants must complete training requirements 1

Critical State-Level Barriers

The elimination of federal waiver requirements does NOT override state-level restrictions, which vary significantly and can substantially limit FNP prescribing authority:

State Prohibitions and Supervision Requirements

• One state completely prohibits all advanced practice clinicians from prescribing buprenorphine for opioid use disorder, despite general scope of practice laws that would otherwise permit it 3
• Five states require physician assistant supervision by a federally waivered physician for buprenorphine prescribing 3
• Three states require nurse practitioner supervision by a federally waivered physician for buprenorphine prescribing 3
• These restrictions exist in addition to general scope of practice laws and apply specifically to buprenorphine prescribing 3

Scope of Practice Variations

• States with full practice authority (like New Mexico and West Virginia) allow NPs to prescribe buprenorphine independently 4
• States requiring physician supervision (like Ohio and Michigan) impose additional barriers even after federal waiver elimination 4
• State scope of practice regulations remain a significant barrier to NP buprenorphine prescribing despite federal deregulation 4

Practical Steps for FNPs

To determine your specific prescribing authority:

1. Verify your state's scope of practice laws for NPs regarding controlled substance prescribing
2. Check for state-specific buprenorphine regulations beyond general scope of practice laws, as these may impose additional supervision requirements 3
3. Confirm whether your state requires supervision by a waivered physician for buprenorphine prescribing specifically 3
4. Ensure you have an active DEA registration with the appropriate schedule II-V authority 1
5. Complete any state-mandated training for opioid use disorder treatment, even though federal training is no longer required 1, 2

Common Pitfalls

• Assuming federal deregulation means unrestricted prescribing: State laws may still impose significant barriers that effectively prevent FNP buprenorphine prescribing 3, 4
• Overlooking state-specific buprenorphine regulations: These exist separately from general scope of practice laws and specifically target buprenorphine prescribing 3
• Failing to verify supervising physician waiver status: In states requiring supervision, the supervising physician may need their own buprenorphine prescribing authority 3
• Not distinguishing between Butrans for pain versus buprenorphine for opioid use disorder: Some state restrictions apply only to opioid use disorder treatment 3

Additional Context

Butrans (buprenorphine transdermal patch) for chronic pain management may have different regulatory requirements than buprenorphine/naloxone (Suboxone) for opioid use disorder treatment in some states 3. The state-specific restrictions identified in the research primarily address opioid use disorder treatment, so verify whether your state distinguishes between these indications.

The persistence of state-level barriers despite federal deregulation represents a significant ongoing challenge to expanding access to buprenorphine treatment 4. Stigma, lack of supportive services, and regulatory complexity continue to limit NP engagement in medication-assisted treatment 4.