New Training Requirement for Controlled Substance Rx: Answers to Common Questions

A new law requires prescribers of controlled substances in schedules II, III, IV, and V to complete a one-time eight-hour training prior to their first registration or renewal of their DEA license, beginning June 27, 2023.

The required training for physicians focuses on “treatment and management of patients with opioid or other substance use disorders, or the safe pharmacological management of dental pain and screening, brief intervention, and referral for appropriate treatment of patients with or at risk of developing opioid or other substance use disorders.”

The following information reflects this new requirement and associated agency guidance as of June 2023. Related state laws and regulations still apply.

New Free CME

Understanding Pain Management and Opioids

This free-for-members CME meets the DEA mandated 8 hours of Medication Access and Training Expansion (MATE) Act

Jump to a section: Eligibility | Timeframe and Documentation | Compliance | X-waiver

Eligibility

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.

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.

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.

Timeframe and Required Documentation

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.

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.

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.

Compliant Trainings

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.

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

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.

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.

The AAFP’s substance use disorder on-demand CME is compliant.

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.

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

X-waiver/DATA 2000 Waiver

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.