Administering Buprenorphine in the Emergency Department Without an X-Waivered DEA Number
In the case presented, a 20-year-old man with opioid withdrawal symptoms is brought to the emergency department (ED) for evaluation and treatment. The provider orders sublingual buprenorphine/naloxone for his management but receives a call from the hospital pharmacist stating that an X-Waivered DEA number is required to administer buprenorphine in the ED. This essay will address whether it is accurate to say that buprenorphine cannot be administered in the ED without an X-Waivered DEA number.
Background on X-Waiver and Buprenorphine
An X-Waiver refers to a special certification obtained by healthcare providers that allows them to prescribe and dispense buprenorphine for the treatment of opioid use disorder (OUD). Buprenorphine is an effective medication for managing opioid withdrawal and maintenance treatment, and its use has been shown to reduce illicit opioid use, overdose deaths, and other adverse outcomes associated with opioid dependence.
Emergency Department Use of Buprenorphine
In response to the opioid epidemic and the need for timely access to evidence-based treatments, the Drug Enforcement Administration (DEA) issued a new rule in 2021 that allows emergency departments to administer buprenorphine without an X-Waiver for the purpose of initiating treatment for OUD. This rule aims to expand access to buprenorphine and provide immediate intervention for patients experiencing opioid withdrawal or overdose.
The new rule permits eligible healthcare providers in ED settings to administer buprenorphine for a maximum of 72 hours or until the patient can be referred for follow-up care. There are specific requirements for this provision, including:
Eligible healthcare providers: The rule allows physicians, physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, and certified nurse-midwives who are otherwise authorized to prescribe controlled substances to administer buprenorphine without an X-Waiver in the ED.
Training and notification: Healthcare providers must have completed at least eight hours of training on the treatment of OUD, including the use of buprenorphine. They must also notify their respective state’s opioid treatment program (OTP) or SAMHSA-certified practitioner of their intent to initiate buprenorphine treatment.
Collaboration and referral: Providers must establish a plan for referral or follow-up care, either through direct linkage with an OTP or by arranging appropriate care for ongoing treatment after the ED visit.
Documentation: Accurate documentation of the buprenorphine administration and follow-up plan in the patient’s medical record is essential.
Conclusion
The pharmacist’s statement that the provider cannot administer buprenorphine in the ED without an X-Waivered DEA number is not accurate under the current regulations. The new rule allows eligible healthcare providers in emergency departments to administer buprenorphine for a limited period without an X-Waiver. However, it is crucial for healthcare providers to ensure they meet the specific requirements outlined by the DEA, including appropriate training, notification, collaboration, and documentation. By leveraging this provision, emergency departments can play a critical role in providing immediate intervention and initiating treatment for patients with opioid use disorder.
Our orders are delivered strictly on time without delay 
