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In late April, the U.S. Department of Health and Human Services published new Practice Guidelines for the Administration of Buprenorphine for Treating Opioid Use Disorder. The updated guidelines remove a longstanding requirement to complete hours (as few as eight or as many as 24) of training before the federal government will grant a waiver or “Notice of Intent” that allows a clinician to prescribe buprenorphine. Clinicians who obtain authorization to prescribe without completing training will be limited to treating no more than 30 patients with buprenorphine.

Forum editor Jean Fisher Brinkley spoke about the recent rule change with Dr. Blake Fagan, a family physician at the Mountain Area Health Education Center (MAHEC) in Asheville, who is chief education officer at UNC Health Sciences at MAHEC. Fagan directs the office-based opioid treatment services provided at MAHEC’s family health centers and trains healthcare providers and medical residency programs across the state in medication-assisted treatment, safe pain management, and safe opioid prescribing practices.


Jean Fisher Brinkley: Is the recent rule change good for patients in need of treatment for opioid use disorder? How so, or why not?

Blake Fagan, MD: The recent rule change will be good for patients because the waiver training was a barrier to providers. Now, more providers will obtain the Notice of Intent to prescribe buprenorphine. Buprenorphine can be a lifesaving and life-changing medication for patients with opioid use disorder.

JFB: What types of clinicians do you expect will take advantage of the relaxed requirements?

BF: Clinicians in primary care, emergency medicine, and hospital medicine will most likely take advantage of the Notice of Intent to prescribe buprenorphine. However, any clinician can obtain a notice of intent to prescribe buprenorphine. Eliminating the waiver training requirement will make it easier for patients with opioid use disorder to access treatment at the point of care in a variety of medical settings and community-based clinics, which will help eliminate barriers to treatment and the stigma that is associated with addiction.

JFB: What is the best way for someone who is interested in getting started with buprenorphine to learn more?

BF: Now that the formal MAT waiver training (8-24 hours of mandatory CME) is not required, providers interested in prescribing buprenorphine through the Notice of Intent can have technical assistance calls for free from experts through the Opioid Response Network and CA Bridge. The Mountain Area Health Education Center also offers a one-hour online introduction to the use of medication for opioid use disorder and virtual case-based education on safe chronic pain management including medication-assisted treatment with buprenorphine.