All About the X Waiver

Buprenorphine Basics

What is an X Waiver?

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. 

What has changed? NEW Updated April 28, 2021

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.

Who Can Become X Waivered?

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.

How Can I Get X Waivered?

Step 1 NOW OPTIONAL- CAN SKIP to STEP 2 WITHOUT COMPLETING TRAINING:

Complete buprenorphine training. 8 hour for physicians, 24 hours for nurses, and 24 hours for PAs.

Step 2:

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

Are you a Penn provider, looking to e-prescribe buprenorphine?