The Only Publication for the Nation's Waivered Buprenorphine Prescribers


Across the country, practitioners continue to respond to the national opioid epidemic, in part by applying for new buprenorphine waivers at a record pace. More practitioners have applied for and received Drug Addiction Treatment Act (DATA) waivers in the past 16 months than during any similar period in the history of the program, which dates to 2002.

This unprecedented growth in the number of new DATA–waivered practitioners owes greatly to the influx of nurse practitioners (NPs), physician assistants (PAs), and physicians who specialize in addiction and family medicine. As noted in the winter 2017 SAMHSA buprenorphine e-newsletter, previously certified NPs and PAs became eligible in February 2018 to apply to increase their DATA waiver limits to the 100-patient level. So far, more than 350 midlevel practitioners have used this new rule to become certified to provide buprenorphine treatment at the 100-patient level, greatly increasing the capacity for care in their communities. The influx of capacity from the NPs and PAs further supports the 43,000 physicians already eligible to treat patients at the 30-, 100-, and 275-patient levels.

Analysis shows that, based on recent averages, nearly 400 practitioners join the program or add capacity to their existing waivers each week.

Looking to apply for a DATA waiver, or to increase your current waiver level? Find out more from the SAMHSA website by clicking here.

Figure 1. Counts of DATA–Waivered Practitioners, as of June 4, 2018
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SAMHSA has supported data analysis to identify the areas of greatest need, partially in response to the finding of the President’s Commission on Combating Drug Addiction and the Opioid Crisis that federal agencies should be analyzing and sharing information about the crisis and collaborating on actions. With this call to action in mind, SAMHSA supported the analysis of locations of DATA–waivered practitioners, along with the analysis of Centers for Disease Control and Prevention (CDC) Wonder data on 2015 opioid overdose deaths. Both sets of data were then overlaid with rural and urban commuting area (known as RUCA) codes. The results showed that, in 2015, practitioners who were waivered at the 30-patient level or at the 100-patient level were heavily represented in the Northeast, the Southeast, and on the West Coast. DATA–waivered practitioners were not, however, well represented in Middle America, especially in rural areas (see Figure 2, below left).

A follow-up analysis found that the same pattern held true in 2017 (see Figure 3, below right). Part of this pattern is due to the lower density of populations in rural areas. Also, in more highly populated urban areas, high numbers of DATA–waivered practitioners might still not be adequate to meet the needs of the more numerous populations. Nevertheless, it is important to keep in mind that even with the addition of the 275-patient limit and the 275-emergency DATA waivers, as well as the addition of NPs and PAs, rural America still does not have adequate coverage.

Figures 2 and 3 (click on the figures to enlarge)
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Rural areas are not the only places where the rates of opioid overdose deaths are high and the need for waivered practitioners is great. According to CDC Wonder data for 2015, the five states with the highest rates of opioid overdose deaths, in order of need for additional waivered practitioners, were North Carolina, Kentucky, Ohio, West Virginia, and Tennessee. Even in urbanized states where the numbers of waivered practitioners are high, such as Massachusetts, the rates of overdose deaths can also be high.

To shed more light on the availability of waivered practitioners in states and counties throughout the nation, and on how they can more effectively target their efforts to address the opioid crisis, SAMHSA is now analyzing CDC’s 2016 mortality data on the underlying causes of death.

As noted above, practitioners are becoming certified to prescribe buprenorphine or adding capacity to their existing waivers rapidly. SAMHSA means to ensure that the momentum continues until the end of the opioid epidemic.

Stay tuned for further updates.

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Practitioners applying to treat, dispense, or prescribe buprenorphine for opioid dependence will be asked to fill out a Notification of Intent (NOI) form for certification.

When filling out your NOI, make sure to type your practicing address. If you mark the box giving consent to publish your address, you will want your practicing address (not your personal address) published.

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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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