HHS Policy Change Gives Most Doctors Permission to Prescribe Buprenorphine for MAT

After years of pressure from the behavioral health industry, the U.S. Department of Health and Human Services (HHS) is making it easier for physicians to prescribe a popular medication-assisted treatment (MAT) drug for opioid use disorder (OUD).

The department is doing that by removing some certification requirements that physicians were previously required to meet before they were allowed to prescribe buprenorphine. As a result, nearly all of the doctors in the U.S. will now be able to prescribe the medication.

The move is expected to improve access to MAT, which can be hard to come by, especially in rural areas.


In fact, a 2020 report by HHS indicated that about 40% of U.S. counties lack a single provider authorized to dispense buprenorphine, and nearly 75% of those counties are located in rural areas.

Red tape is one reason for that: Doctors have typically been required to complete an eight hour training course before they could receive a license, or X-waiver, to prescribe buprenorphine to patients. Behavioral health stakeholders have long denounced the process, saying the burden prevents providers from seeking licenses, in turn preventing countless OUD patients from receiving the treatment they need. 

HHS’s new policy change will help with that, at least for doctors.


Under the new rules, any physician with a DEA prescriber license can prescribe in-state patients buprenorphine. Most doctors will be permitted to treat up to 30 patients, with hospital-based physicians allowed to treat more. Doctors who aren’t based in hospitals can also treat more than 30 patients if they undergo training and receive a waiver.

Meanwhile, the new policy doesn’t apply to nurse practitioners (NPs) or physician assistants (PAs), who still must complete a 24-hour training course and receive an X-waiver in order to prescribe buprenorphine. 

Still, the policy change is progress, and groups such as the American Medical Association (AMA) have spoken out in support of the new rules.

“The AMA strongly endorses today’s decision by HHS to allow physicians to prescribe without a waiver highly effective medication for the treatment of patients with opioid use disorder,” former AMA President Patrice Harris said in a statement. “Patients are struggling to find physicians who are authorized to prescribe buprenorphine; the onerous regulations discourage physicians from being certified to prescribe it.”

A nationwide increase in drug overdoses, especially during the COVID-19 emergency, ultimately prompted HHS to make the decision, assistant health secretary Brett Giroir said Jan. 14 on a media call.

“The medical evidence is clear: access to medication-assisted treatment, including buprenorphine that can be prescribed in office-based settings, is the gold standard for treating individuals suffering from opioid use disorder,” Giroir said in a press release announcing the news. “Removing some of the certification requirements for an X-waiver for physicians is a step toward providing more people struggling with this chronic disease access to medication assisted treatment.”

Currently, about 66,000 doctors and about 25,000 other prescribers have X-waivers, Giroir said.