The Only Publication for the Nation's Waivered Buprenorphine Prescribers


In 2016, two important governmental efforts increased access to treatment for Americans with opioid use disorder. First, under the Comprehensive Addiction and Recovery Act of 2016, nurse practitioners (NPs) and physician assistants (PAs) became eligible to apply to prescribe buprenorphine. Since February 2017, more than 4,500 midlevel practitioners practicing in the United States have applied and become licensed.

Second, under an August 2016 U.S. Department of Health and Human Services (HHS) Secretary Rule, physicians (with a specialty in addiction medicine or psychiatry or working in a quality practice location) licensed to prescribe to up to 100 patients first became eligible to increase their waiver limit to 275 patients. So far, nearly 3,800 physicians have done so.

Anniversary Dates Approaching for Many Buprenorphine Prescribers
Anniversary dates are approaching for many of the nation's practitioners certified to prescribe buprenorphine as a medication-assisted treatment for opioid addiction to increase their patient limits. For example, more than 21,000 physicians licensed to prescribe at the 30-patient limit will have had their certification for at least one year as of Dec. 31, 2017, and thus will be eligible for an increase.

NPs and PAs Become Eligible in February to Increase Their Patient Level to 100
Late February will mark one year since NPs and PAs first became eligible to apply to prescribe buprenorphine. Their anniversary dates will allow them to apply for an increased patient limit.

As of Feb. 28, 2018, NPs and PAs who have been certified to prescribe buprenorphine to up to 30 patients may apply for waivers to increase their patient level to 100. The actual date on which individual NPs and PAs may apply for the increase is the one-year anniversary date of receipt of their application to prescribe to 30 patients.

Thus, if you applied Feb. 28, 2017, you may apply for the increase beginning Feb. 28, 2018. If you applied for certification to prescribe to 30 patients on March 1, 2017, then you may apply for an increase to 100 patients beginning on March 1, 2018. And so on.

Physicians at the 275-Patient Level Are Required to Submit Annual Reports
Physicians certified to prescribe buprenorphine at the 275-patient limitation must submit an annual report to SAMHSA about their activities within 30 days following the one-year anniversary of their waiver approval date. If they fail to submit an annual report by the due date, their patient limit may be reduced to 100 (the previous authorization cap before 275).

The annual report must include:
  • The physician's annual caseload of patients by month
  • Numbers of patients the physician provides with behavioral health services and referred to behavioral health services
  • A description of the physician's diversion control plan
To remain at the 275-patient limit, practitioners must continue filing an annual report each year afterward. SAMHSA may audit the reports and, should any discrepancies appear between an annual report and other data sources, require additional documentation from practitioners.

Missing the deadline and seeing their patient limit fall to 100 would affect the health and safety of the patients. For many opioid-dependent persons, finding someone nearby to prescribe buprenorphine a first time is difficult. It may be equally hard the second time. To view a sample of the annual report, please click on this link. Please note that this is a sample only. Do not submit your report before your anniversary date. SAMHSA will send you a notification by e-mail 30 days before it is due.

Most Certified Physicians Are Still Prescribing at the 30 Limit
As of data reviewed Nov. 28, 2017, more than two of every three physicians certified to prescribe buprenorphine were waivered at the 30 limit—which makes sense, given that a practitioner must work under that ceiling for one year before applying to prescribe to up to 100 patients. Likewise, more than twice as many physicians are certified to prescribe to 100 patients as the number who may prescribe to the maximum level of 275 (see Figure 1, below).
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Among midlevel practitioners—nurse practitioners and physician assistants—certified to prescribe buprenorphine, the NPs outnumber the PAs by almost a 4:1 ratio (again, using Nov. 28, 2017, data; see Figure 2, above).

The table below shows the number of physicians licensed to prescribe at the 30, 100, and 275 levels—as well as the number of NPs and PAs (at the 30 level only)—by state and territory. Every U.S. state has at least one practitioner at the 275 level.

In the New Year, SAMHSA plans to develop and share with the public national and state maps that will reveal areas of high mortality (counties with a high per capita rate of opiate overdose deaths), areas of greatest need (counties with no certified practitioners), and areas with high mortality and an insufficient number of certified practitioners. So stay tuned.
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This is the second issue of SAMHSA's Buprenorphine Prescriber News. (You can read the first issue here.) Each issue brings you news about the evolving opioid crisis, which President Trump recently declared "a national public health emergency." The current issue addresses waiver numbers for buprenorphine prescribers. Future issues will address opioid prescription practices, opioid use, opioid overdoses, opioid overdose deaths, buprenorphine treatment, and policy and program issues and actions, as well as announcements about upcoming events and links to helpful resources.

Existing Prescribers Interested Practitioners Need Help Getting Started?
SAMHSA's Opioid Overdose Prevention Toolkit provides information to help those at risk avoid overdose and to educate families, communities, and health workers about the potential for overdose, as well as the dangers of opioid misuse and abuse.

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The views, opinions, and content of this publication do not necessarily reflect the views, opinions, or policies of SAMHSA or the U.S. Department of Health and Human Services.