How to Get a Buprenorphine Waiver

A buprenorphine waiver is a legal certification allowing a medical professional to write prescriptions for Suboxone.

Before 2021, doctors had to finish eight hours of training to prescribe buprenorphine. Just 5% of providers did this, and few worked in rural areas, which made access to Suboxone challenging for many patients.[1]

Legislation changed all that, and now, prescribing buprenorphine is easier. But medical professionals must still jump through a few extra hoops before writing a prescription for buprenorphine products. 

What Is a Buprenorphine Waiver?

A buprenorphine waiver is a type of certification that allows a doctor or other qualified medical professional to write prescriptions for products containing buprenorphine. Doctors with these waivers have a number beginning with X that they can write on any prescription for buprenorphine.

This so-called "X-waiver" is valid in all states and USA territories.[2] A doctor opening a new practice in another state doesn't need a new waiver. 

Rules for Treating 30 Patients or Fewer 

Some doctors have just one or two people for whom they prescribe Suboxone for an opioid use disorder (OUD). These medical professionals don't want to open up addiction clinics, but they want to help people in need. Special rules apply to them.

A practitioner who wants to treat 30 patients or fewer must do the following:[3]

• Notify: That medical professional must tell SAMHSA's Center for Substance Abuse Treatment Division of Pharmacologic Therapies of their need to prescribe buprenorphine. 
• Apply: The provider must then submit an application or notification of intent.

No training is required in this model. But some doctors may choose to learn more about the drugs before they offer them to patients. 

Rules for Treating Up to 100 Patients

Some doctors want to help many more patients, and they need extra permission to do so.

These providers must follow the steps to notify and apply (just as they would if they wanted to treat 30 patients). But they must also complete buprenorphine training. Once they have done so, they can apply for a waiver to treat many patients.

These providers must also prove that they comply with one or the two following conditions:[3]

1. The provider is board certified in addiction medicine or addiction psychiatry.
2. The person works in a qualified practice setting, such as an addiction clinic. 

It is important to note that these are general rules, and that they may not apply in all states and locations. Rules around Suboxone prescribing are quickly changing, in order to expand access to more patients that need treatment. Some states are discontinuing the waiver requirement altogether. If you have questions about the Suboxone certification in your state, there are a number of online resources that can help.

Sources

1. New Buprenorphine Practice Guidelines: FAQs. Society of Hospital Medicine. https://www.hospitalmedicine.org/globalassets/practice-management/practice-management-pdf/x-waiver-faq.pdf. May 2021. Accessed July 2022.
2. FAQ for Buprenorphine Waiver Applicants and Certified Practitioners. Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/medication-assisted-treatment/become-buprenorphine-waivered-practitioner/buprenorphine-waiver-faqs. March 2022. Accessed July 2022.
3. Become a Buprenorphine Waivered Practitioner. Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/medication-assisted-treatment/become-buprenorphine-waivered-practitioner#training. April 2022. Accessed July 2022.
4. Overview of Medications for Opioid Use Disorder. Providers Clinical Support System. https://pcssnow.org/medications-for-opioid-use-disorder/. Accessed July 2022.