An “X waiver” refers to the Drug Addiction Treatment Act (DATA 2000) “waiver” legislation that authorized the outpatient use of buprenorphine for the treatment of opioid use disorder.
Any clinician can administer buprenorphine to a patient with opioid withdrawal symptoms in the hospital. However, in order to write prescriptions for buprenorphine, clinicians must have an X Waiver. The X waiver previously required an 8 hour (physician) or 24 hour (APP) training prior to applying for the waiver. This has changed and the training certificate is no longer required. However, clinicians still need to apply for their waiver. See below for instructions.
Physicians, Nurse Practitioners (NPs), Physician Assistants (PAs), Clinical Nurse Specialists (CNSs), Certified Registered Nurse Anesthetist (CRNAs), and Certified Nurse-Midwifes (CNMs) can all obtain the waiver without completing the training. However, the FREE training is still available online. See here for more details.
Step 1 NOW OPTIONAL- CAN SKIP to STEP 2 WITHOUT COMPLETING TRAINING:
Fill out the Buprenorphine Waiver Notification of Intent (NOI) form from the Substance Abuse and Mental Health Services Administration (SAMHSA). INSTEAD of uploading your training certificate from step 1 which is no longer mandatory, when the system asks for your Certification Qualification Criteria, check “Other” and write in “Practice Guidelines.”
These waiver applications are forwarded to the DEA, which assigns you a special designation. DEA regulations require this prefix “X” number to be included on all buprenorphine prescriptions for opioid use disorder treatment and precedes your regular DEA registration number.
It may take up to 45 days for your application to be verified on the SAMHSA website. You can check your status here.
EPrescribing Narcotic Addiction Medication w/ the Narcotic Addiction DEA number or X-waiver.
Suboxone (and all buprenorphine-containing drugs) will need additional steps completed to be e-prescribed. When attempting to e-prescribe these medications the provider will receive an inline order validation message. The message prompts for NADEAN: This terminology is referring to the provider’s X waiver number. The X waiver number is your usual DEA number preceded with the letter X (if you have completed your X waiver training). Preface with NADEAN: to have the number passed to the pharmacy.
To complete the e-prescribe process-