Timeline of Buprenorphine as Medication for Opioid Use Disorder (MOUD) Regulatory Changes
| 1974 | Narcotic Addict Treatment Act (NATA) | Requires special DEA registration to dispense (but not prescribe) MOUD, creating OTPs (opioid treatment programs). Effectively creates Methadone clinics as they exist today. |
| 2000 | DATA (Drug Addiction Treatment Act) 2000 | Exempts buprenorphine from OTP regulations. Allows physicians to prescribe buprenorphine as MOUD but requires an 8-hour training, a special registration with the DEA, and limits the number of patients per clinician (or group practice) to 30. Creates the X-waiver program. |
| 2005 to 2006 | Amendments to DATA 2000 | Remove the group practice limit, introduces 100 patient limits for physicians holding an X-waiver for at least one year (must apply). |
| 2016 | CARA (Comprehensive Addiction and Recovery Act) | Introduces option for Nurse Practitioners (NP) and Physician Assistants (PA) to apply for a 30-patient X-waiver (with 24 hours of certified training). |
| 2018 | SUPPORT (Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities) Act | Certain physicians holding a 100-patient X-waiver for at least 1 year may apply for a 275-patient limit if their practices meet certain requirements. NPs and PA’s holding 30-patient X-waiver for 1 year can apply for 100-patient X-waiver. |
| 2020 | Easy MAT | Practitioners can dispense (but not prescribe) up to a 3-day supply of buprenorphine without an X-waiver (useful for Emergency Room clinicians) |
| 2021 | Executive Action | Physicians, NPs, and PAs are allowed to apply for an X-waiver with a 30-patient limit without the 8- or 24-hour training requirement. |
| 2022 | MAT (Mainstreaming Addiction Treatment) and MATE (Medication Training and Expansion) Acts | Eliminates the X-waiver program entirely. Buprenorphine is now treated like any other schedule 3 medication when prescribed as MOUD. Institutes new 8-hour addiction treatment training requirement for all clinicians at time of DEA license renewal. |
Abbreviation: DEA, Drug enforcement agency.
Note: Information from references.3,4,28