Substance Use Disorders Edition 2

Alcohol Use Disorder: Screen, Diagnose, Treat and Support
Joyce Troxler, MD

Considering the Patient Perspective
Elizabeth Salisbury-Afshar, MD, MPH, FAAFP, DFASAM, FACPM; Brandon George

Emerging Psychoactive Substances: Fentanyl, Kratom and Xylazine
Jasleen Salwan, MD, MPH

Harm Reduction and Addressing Stigma
Elizabeth Salisbury-Afshar, MD, MPH, FAAFP, DFASAM, FACPM

Harm Reduction: Any Positive Change
Elizabeth Salisbury-Afshar, MD, MPH, FAAFP, DFASAM, FACPM

Intake Assessment and Care Coordination
David O’Gurek, MD

Interpretation of Toxicology Results
Anika Alvanzo, MD, MS, DFASAM, FACP

Managing Common Comorbidities: Sleep, Anxiety and Depression
Sky Lee, MD, AAHIVS

Principles of Motivational Interviewing
David O’Gurek, MD

Smoking Cessation and E-Cigarettes
Marie-Elizabeth Ramas, MD, FAAFP

Stimulant Use Disorder: The Tools in Our Toolbox
Hannah Snyder, MD

Substance Use Disorders Edition 2 Reflection and Translation to Practice^® (t2p^®)
David O’Gurek, MD

The Evidence Base for Treatment of OUD
Elizabeth Salisbury-Afshar, MD, MPH, FAAFP, DFASAM, FACPM

The Impact of Drug Policy on SUDs
Elizabeth Salisbury-Afshar, MD, MPH, FAAFP, DFASAM, FACPM; David O’Gurek, MD; Jason Glenn, PhD

Trauma-informed Care
David O’Gurek, MD

Treatment of OUD with Buprenorphine Part 1: Initiation of Treatment
Nicole Gastala, MD

Treatment of OUD With Buprenorphine Part 2: Follow-up Visits and Maintenance
Margaret Lowenstein, MD, M. Phil., MSHP

What Is Addiction?
Elizabeth Salisbury-Afshar, MD, MPH, FAAFP, DFASAM, FACPM

*Enhance your patient care today and earn up to two additional AAFP Prescribed credits for when you complete the Translation to Practice^® (t2p^®) process.

David O’Gurek, MD—Course director

Speakers:

• Anika Alvanzo, MD, MS, DFASAM, FACP
• Brandon George
• David O’Gurek, MD—Course director
• Elizabeth Salisbury-Afshar, MD, MPH, FAAFP, DFASAM, FACPM
• Hannah Snyder, MD
• Jasleen Salwan, MD, MPH
• Jason Glenn, PhD
• Joyce Troxler, MD
• Margaret Lowenstein, MD, M.Phil., MSHP
• Marie-Elizabeth Ramas, MD, FAAFP
• Nicole Gastala, MD
• Sky Lee, MD, AAHIVS

Do I need to complete this training?

If you finished your residency program more than five years ago and are a prescriber of schedules II through V medications, you’ll need to attest that you’ve completed this training when you obtain or renew your DEA license. SAMHSA's latest guidance indicates that anyone who previously held an X-waiver does not need to complete additional training under this new requirement. (Note: This does not apply to practitioners who received a 30E waiver during the COVID-19 pandemic.)

Read more below about past trainings you may have already completed that meet this requirement.

What if I’m a recent graduate?

If you graduated from medical school within the five years immediately preceding June 27, 2023, and received at least eight hours of training related to SUD and safe prescribing for pain while in school or residency, you do not need to complete additional training. When you obtain or renew your DEA license, there will be a box to check that indicates you graduated within the previous five years and therefore have satisfied the new training requirement.

In June, SAMHSA released new guidance indicating it interpreted "medical school" as including residency and fellowships. Under this interpretation, if you completed residency or a fellowship (not just medical school) in the past five years and received the requisite SUD and safe-prescribing training, you do not need to complete additional training.

The DEA is not requesting documentation related to medical school or residency training to comply with this law. However, saving course overviews or specific hours of classes and training related to SUD screening, treatment, or safe prescribing will ensure that you have documentation on hand should you ever need it during a DEA audit for other purposes.

What if I’m about to graduate or am still in medical school?

The five-year timeframe for recent graduates is rolling—for example, if you plan to graduate, complete residency and obtain your DEA license in 2025, you will still be able to check a box that indicates you graduated within the past five years and received this training as part of your education.

When do I need to complete this new training?

All eight hours required by this new law must be completed before your next DEA license renewal date or before obtaining your DEA license for the first time.

How often do I need to complete this training?

This is a one-time requirement. Once you’ve attested to completing this training, you will not be required to complete any additional training under current law. The DEA will not require you to attest to this training after your first attestation.

What documentation do I need when renewing my DEA license?

The DEA will ask only for attestation, meaning you will not need to provide additional documentation. However, there is an expectation that you will be able to provide documentation if requested. DEA and SAMHSA have not provided guidance on what documentation they would request, but CME certificates, letters of participation, or course overviews if you’re in med school or residency are good examples.

During a listening session, the DEA stated that it will not perform audits specific to MATE Act compliance, but it could be included as part of other audits.

What topics need to be included in the training?

SAMHSA has provided recommended core elements and content of SUD curricula in this guidance. These recommendations, along with the accreditation criteria below, will help you determine what past or future trainings are compliant with the new requirement.

Do previous trainings count toward the eight hours required under this new law?

Yes, many past trainings count toward this requirement, including those in classroom settings, seminars at professional society meetings, virtual offerings, and more. Also included is training you may have received in order to obtain the now-defunct x-waiver (see below) to prescribe buprenorphine.

Past trainings must have been offered or approved by:

• The American Society of Addiction Medicine (ASAM)
• The American Academy of Addiction Psychiatry (AAAP)
• The American Medical Association (AMA)
• The American Osteopathic Association (AOA) or any organizations accredited by the AOA to provide continuing medical education
• The American Dental Association (ADA)
• The American Association of Oral and Maxillofacial Surgeons (AAOMS)
• The American Psychiatric Association (APA)
• The American Association of Nurse Practitioners (AANP)
• The American Academy of Physician Associates (AAPA)
• The American Nurses Credentialing Center (ANCC)
• Any other organization accredited by the Accreditation Council for Continuing Medical Education (ACCME) or the Commission for Continuing Education Provider Recognition (CCEPR), whether directly or through an organization accredited by a state medical society that is recognized by the ACCME or CCEPR
• Any other organization approved or accredited by the Assistant Secretary for Mental Health and Substance Use, the ACCME, or the CCEPR

How do I know if the training I took was accredited/approved by the ACCME or other state medical societies approved by the ACCME?

You can review the letter of participation and look for the ACCME Accreditation Statement and AMA PRA Category 1 credit statement. For assistance in determining if past courses you have taken or to locate future AAFP courses that will meet this requirement, please reach out to the AAFP Member Resource Center.

Which of the past AAFP educational offerings qualify?

The AAFP is ACCME accredited, but not all state chapters are ACCME accredited. Any educational offering provided by the AAFP for which you can or did receive credit from ACCME, the AOA, the AMA, or any of the above-listed organizations will count. If you completed training through your state chapter, check with your state chapter or the AAFP’s member resource center.

Where can I complete additional training hours?

Most of the AAFP’s CME live sessions or on-demand offerings are compliant with this new requirement, as long as they cover opioid use disorder, SUD pain management, substance misuse, and/or other related topics. To maximize Academy members’ options for complying with the new requirement, the AAFP is temporarily making its on-demand SUD training free to members. 

Do activities with AAFP Credit count?

Activities with solely AAFP prescribed or elective credit do not yet count. The AAFP is communicating with SAMHSA to address this oversight.

I thought the X-waiver to prescribe buprenorphine was removed. Is this the same thing?

The X-waiver (also known as the DATA 2000 waiver) is no longer required to prescribe buprenorphine for opioid use disorder. While the X-waiver requirement was removed by the Consolidated Appropriations Act of 2023, it is separate and unique from this new training requirement.

The X-waiver required eight hours of training on OUD screening, treatment, and buprenorphine prescribing each time a practitioner’s waiver was renewed. This is no longer required, and clinicians can prescribe buprenorphine for OUD without a federal X-waiver, when otherwise compliant with applicable federal and state laws. However, SAMHSA's latest guidance indicates that anyone who previously held an X-waiver does not need to complete additional training under this requirement. (Note: This does not apply to practitioners who received a 30E waiver during the COVID-19 pandemic.)

The new training requirement is related to all substance use disorders and safe prescribing, not just OUD and buprenorphine. It is required for all clinicians who prescribe schedules II-V medications. As noted above, unlike the X-waiver, the MATE Act training is a one-time training—once you obtain or renew your DEA license and attest to completing this training, you don’t need to complete more training for subsequent renewals unless your state requires it.