Real Talk with CA Bridge – Hannah’s Story: For the guys at the Recycling Center

Real Talk Podcast

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The Real Talk with CA Bridge series was recorded during an online Real Talk session with the CA Bridge Program Team.

CA Bridge is a program of the Public Health Institute working to ensure that people with substance use disorder receive 24/7 high-quality care in every California health system. CA Bridge integrates addiction treatment into standard medical practice, increasing access to treatment and saving more lives. Learn more at BridgeToTreatment.org.

Notes about Medication for Addiction Treatment (MAT)

Three main medications are used in MAT: Buprenorphine, Methadone, and Naltrexone.

• Methadone for MAT may only be administered through a federally licensed opioid treatment program, and may not be prescribed for outpatient use from the hospital or emergency department.
• Buprenorphine (ex: Suboxone) for MAT can be started in a clinic, hospital, or emergency department and patients can be treated in the ED or acute care setting for up to 3 days without any special licensing or permission. However, in order to write a prescription for buprenorphine, providers must have a DATA2000 waiver for their DEA license ("DEA-X” or “X waiver”).

Obtaining an X-waiver – Requires an 8-hour training for physicians, 24-hour training for Physician Assistants or Nurse Practitioners.

Note: X-waiver trainings include Continuing Medical Education (CME) credits that qualify toward the one-time 12 units on pain management required for all physicians by the CA Medical Board!

There are several ways to complete the X-waiver training, including partial or full in-person training or fully self-guided online training – ex: through Providers Clinical Support System, an initiative from the Substance Abuse & Mental Health Services Administration (SAMHSA). This training is free to any provider.

To complete the FREE Online X-waiver Training through PCSS:

1. Go here: https://pcssnow.org/medication-assisted-treatment/
2. Select your role (physician, PA, etc.) and follow the steps to complete the Online 8-hour MAT Waiver Training (doctors) or the 24-hour training (PAs & NPs)
3. Register (free!) by creating an account, then complete the training and post-test (life pro tip: pay attention to the pre-test!!)
4. At the conclusion of the training, you must submit your completion certificate to apply for the DEA X-waiver (also free!). Instructions can be followed in the pop-up window at the conclusion of the training, or accessed directly at: https://buprenorphine.samhsa.gov/forms/select-practitioner-type.php, or select “Apply for a Practitioner Waiver” from: https://www.samhsa.gov/medication-assisted-treatment/training-materials-resources/apply-for-practitioner-waiver

When applying for the X-waiver:

• CA Physician Assistants must list a supervising physician (typically the department chair or medical director). Note this supervisor is not required to have their own respective X-waiver.
• CA Nurse Practitioners do not need to list a supervising physician
• The waiver limits providers to 30 or 100 patients actively on Buprenorphine for MAT at one time. For most acute care providers, it is unlikely they will ever have more than 100 active Buprenorphine prescriptions being filled/taken by patients at one time, so this limit is not a practical issue. However, if desired, providers who meet specific criteria can apply to increase their patient limit to 275 after one year at the 100-patient limit.

Confirming your X-waiver: It takes about two weeks for a X-waiver application to be processed, but the physical X-waiver card can take much longer to arrive in the mail. The status of an individual provider’s X-waiver can be checked online in the meantime (https://www.samhsa.gov/bupe/lookup-form), and that provider can start prescribing Buprenorphine as soon as they are approved.

A provider’s X-waiver number is the same as their normal DEA number, substituting an X for the first letter of their normal number. (Ex: If a provider’s DEA numbers is FK1234567, their X-waiver number will be XK1234567).

Episode intro music: "Honey and Milk" by The 126ers