Responding to NC’s Opioid Epidemic:
Pilot for PAs and NPs providing Medication-Assisted Treatment (MAT)
About Buprenorphine
Buprenorphine is a safe and lifesaving treatment for opioid use disorder (OUD). The National Academies of Science’s March 2019 consensus report concluded buprenorphine is a “safe and highly effective” medication to treat OUD. A February 2020 JAMA Psychiatry study found that, among six different treatment methods studied—only treatment with buprenorphine and methadone demonstrated a statistically significant reduced risk of overdose across 3- and 12-month periods.
The Comprehensive Addiction and Recovery Act (CARA) expanded eligibility to prescribe buprenorphine for OUD to PAs/NPs. The ability to prescribe buprenorphine for OUD outside of specialized opioid treatment programs—known as the DATA 2000 waiver—was originally granted exclusively to physicians. The enactment of CARA in 2016 expanded waiver eligibility to PAs and NPs. Federal law defers to state law regarding whether or not physician supervision of APPs who prescribe buprenorphine is required.
Requirements
To receive a practitioner waiver to administer, dispense, and prescribe buprenorphine practitioners must notify SAMHSA’s Center for Substance Abuse Treatment (CSAT), Division of Pharmacologic Therapies (DPT) of their intent to practice this form of medication-assisted treatment (MAT). The notification of intent (NOI) must be submitted to SAMHSA before the initial dispensing or prescribing of OUD treatment medication.
Qualified practitioners include physicians (8 hours of waiver training) , Nurse Practitioners (NPs), Physician Assistants (PAs), Clinical Nurse Specialists (CNSs), Certified Registered Nurse Anesthetist (CRNAs), and Certified Nurse-Midwifes (CNMs). Non-physicians must complete 24 hours of specialized training to prescribe buprenorphine, including 8 hours of waiver training and an additional 16 hours of training.
Training
SAMHSA funds the Providers’ Clinical Support System (PCSS) to provide practitioner training in the evidence-based prevention and treatment of OUD and offers the required trainings needed to apply for buprenorphine waiver notifications. Learn more about practitioner buprenorphine training requirements.
- Physician Buprenorphine Waiver Training – 8-hour training
- Nurses Buprenorphine Waiver Training (NPs, CNSs, CRNAs, CNMs) – 24-hour training
- Physician Assistant Buprenorphine Waiver Training – 24-hour training
SAMHSA offers tools, training, and technical assistance to practitioners in the fields of mental and substance use disorders. Find information on SAMHSA training and resources.
In North Carolina, UNC-Chapel Hill and MAHEC provide technical assistance for MAT providers through their ECHO programs.
All mentoring and training are free resources offered to participants in the pilot program.
In one year, GI and NC DHHS will report data on the pilot to the NC Medical Board.