Physicians who must register or renew their registration for a Drug Enforcement Administration license will face a new requirement as of June 27: To register, they will have attest to taking a one-time, eight-hour training on how to treat patients with opioid or other substance use disorders.
DEA registration is renewable every three years, so that still gives many already-registered physicians time to meet the requirement, says Fredericksburg pain specialist Ralph Menard, MD, president of the Texas Pain Society (TPS).
Just as important, many physicians have already met the criteria for the training because of other professional requirements. And those who haven’t have several options – including CME from the Texas Medical Association – for getting trained, according to the U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration (SAMHSA).
Physicians won’t have to submit training-related documentation but should be able to reference it in the event of an audit, Texas Medical Association experts say.
The new requirement came under the Medication Access and Training Expansion (MATE) Act, which Congress passed as part of the Consolidated Appropriations Act of 2023. Under the law, physicians and other health care professionals who prescribe Schedule II, III, IV, and V medications will be required to check a box on their online DEA registration form to show that they have done the training, SAMHSA says.
That means starting June 27, physicians who are new or renewing DEA registrants as of that date will need one of the following upon submission of their application:
- Eight hours of training on opioid or other substance use disorders.
- Board certification in addiction medicine or addiction psychiatry from the American Board of Medical Specialties, American Board of Addiction Medicine, or the American Osteopathic Association (AOA).
- Graduation within five years from a U.S. medical school that included successful completion of an opioid or other substance use disorder curriculum of at least eight hours.
Criteria for the eight hours of CME are flexible because “SAMHSA has elected not to pursue the option to approve specific training organizations” or “undertake a lengthy rulemaking process” about the training, the agency says. Given that, SAMHSA estimates that more than 2,000 organizations offer or plan to offer training that may satisfy the eight-hour requirement.
Qualifying CME options
Those organizations include TMA, which offers several courses totaling 8 hours of relevant CME that is free for members.
Physicians also have flexibility in how to complete the training, says Mesquite pain specialist C.M. Schade, MD, a former TPS president. The training does not have to be completed in one session but can be spread out across multiple sessions that equal eight hours. And the trainings can occur in multiple formats, including in classrooms, seminars, professional society meetings, and online formats.
TPS also is working quickly to develop a single eight-hour course to help physicians meet the DEA requirement, says Dr. Menard.
Other Texas organizations, such as the Texas Opioid Training Initiative, also offer CME that appears to satisfy the mandate.
Physicians can complete the training with the help of national organizations such as the American Academy of Addiction Psychiatry, the American Medical Association, ASAM, AOA, and any organizations accredited by the AOA in CME, DEA says.
While some CME courses are free, others are not, and physician leaders acknowledge many doctors understandably bridle at yet another unfunded, time-consuming professional requirement.
AMA and other physician organizations successfully advocated against the requirement when it was proposed under the MATE Act in 2021. It was later tacked on last minute to the 2023 Consolidated Appropriations Act over medicine's objections.
The American Society of Addiction Medicine endorsed the new requirement, saying lack of standardization in addiction prevention and treatment has hampered the U.S. response to the addiction and overdose crisis.
A mandate with a silver lining?
Michael Sprintz, DO, a Houston specialist in pain, addiction, and anesthesia, sees a silver lining. Virtually all medical practices have at least some patients with undiagnosed substance use disorders and learning the basics can save physicians time and money because they’ll be able to recognize those patients and get them treated.
“It will make your practice easier because you’ll start to see what you couldn’t see before,” said Dr. Sprintz, who is co-writing the curriculum for the TPS training. “An untreated substance use disorder is a real challenge to a practice. … Being able to identify a patient with a [substance use disorder] and helping to get appropriate treatment helps the patient, the practice, and the health care system overall.”
The MATE training is not to be confused with the X waiver – a requirement for prescribing buprenorphine that the Consolidated Appropriations Act did away with, Dr. Schade says. That waiver required not only eight hours of training but also rigid documentation rules for prescriptions and the potential for inspection by DEA agents.
Replacing the X waiver requirements with this broader training on substance use disorder for all health care professionals registering with DEA represents progress, he says.