Opioid regulation: buprenorphine prescribing, MATE training and PDMPs

Since the 2023 MAT Act, any clinician with a DEA registration covering Schedule III can prescribe buprenorphine for opioid use disorder, while methadone for OUD stays limited to opioid treatment programs; all DEA registrants owe a one-time 8-hour training.

1. The X-waiver is gone. Section 1262 of the Consolidated Appropriations Act, 2023 removed the federal requirement to submit a Notice of Intent before prescribing buprenorphine for opioid use disorder ¹.
2. Schedule III authority is enough. Practitioners with a current DEA registration including Schedule III may prescribe buprenorphine for OUD if state law permits; patient limits, discipline restrictions and counseling certification were also removed ¹.
3. A one-time training is required. The MATE Act created an 8-hour training on treating and managing substance use disorders for all DEA-registered practitioners except solely veterinarians ².
4. It is affirmed at registration. From June 27, 2023, practitioners check a box on their next initial or renewal DEA registration; the affirmation is not repeated at later renewals ².
5. Methadone for OUD is restricted. Ongoing methadone treatment for opioid use disorder can be provided only through an opioid treatment program ³.
6. Check the PDMP. CDC recommends reviewing state prescription drug monitoring program data when starting opioids for acute, subacute or chronic pain and periodically during long-term therapy, to spot dosages or combinations that raise overdose risk (category B) ³.

Any clinician may administer, but not prescribe, methadone or buprenorphine for acute opioid withdrawal for up to 3 days while arranging referral; in 2020 Congress directed DEA to allow a 3-day supply ³.

• Board certification in addiction medicine or addiction psychiatry satisfies the MATE training requirement ².
• Recent graduates whose curriculum included at least 8 hours of substance use disorder training within 5 years of June 27, 2023 are deemed compliant ².
• In June 2026 SAMHSA decommissioned its waiver notification system and removed individual buprenorphine-prescriber search from FindTreatment.gov ¹.
• CDC recommends building risk mitigation, including offering naloxone, into opioid management plans (category A) ³.
• MATE hours can be cumulative across sessions, and past DATA-waiver trainings count toward the 8 hours ².
• Reassess patients on long-term opioids about every 3 months, more often when risk is higher, such as at 50 MME/day or more or with sedatives ³.
• Buprenorphine or methadone after nonfatal overdose is associated with fewer all-cause and opioid-related deaths ³.

• Telling a clinician they still need an X-waiver to prescribe buprenorphine ¹.
• Prescribing methadone for opioid use disorder from an office practice ³.
• Thinking the 8-hour training must be repeated at every renewal ².
• Stopping buprenorphine abruptly; if discontinued it should be tapered very gradually, over several months ³.