CRNAs and Medication-Assisted Treatment (MAT)
New – September 2019 The medication-assisted treatment (MAT) waiver is now available for CRNAs to apply. Please see additional information and the process and steps below.
The AANA supports increased patient access to safe, responsible use of MAT for the comprehensive treatment of substance and opioid use disorder.
MAT Waiver Information and Process to Apply
The waiver application for CRNAs as qualifying other practitioners to prescribe buprenorphine as medication-assisted therapy in office based settings is now available. Information on the process and steps:
- Please review the AANA position statement and considerations document Certified Registered Nurse Anesthetists Medication-Assisted Treatment for more information on MAT, a CRNA's ethical obligation and professional responsibility, prescriptive authority limitation.
- Verify your state's regulations allow CRNAs to prescribe buprenorphine and other medications to treat opioid use disorder (OUD). AANA Prescriptive Authority Map (member login required). Questions: contact your state board of nursing, see NCSBN directory.
- If you do not already have one, apply for a DEA number.
- See SAMHSA conditions to meet qualified practice setting requirements for "qualifying other practitioners" (CRNAs are in this group) to prescribe MAT to treat up to 100 patients in the first year of waiver receipt.
- Meet education requirement to quality for waiver application:
- No need to pay for education, offerings are free.
- CRNA education requirements are the same as the NP and PA (category of other practitioners) to complete 24 hours initial education, which includes 8 hours of MAT training and 16 hours of additional related education.
- The additional 16 hour requirement must be completed by one of the following three organizations; all 16 hours must be from the same organization:
- More info: see SAMHSA training links below
- Apply for the waiver - see SAMHSA Apply for a Practitioner Waiver page
- Follow Online Request for New Waiver link
- On second page of the application, select APRN as practitioner type and CRNA as practitioner sub-type.
- "Apply for a Practitioner Waiver" page also includes additional information on the process such as faxing training certificate, the review and confirmation process, and increasing patient limit.
- Buprenorphine waiver inquiries: Call 866-BUP-CSAT (866-287-2728) or email firstname.lastname@example.org
- Follow Online Request for New Waiver link
After one year at the 100 patient limit, qualified other practitioners who meet the criteria can apply to increase their patient limit to 275. MAT prescribing privileges for CRNAs available until October 1, 2023.
October 2019: New from PCSS, Improving Clinical Practice with Patients who have Opioid Use Disorder: Performance-in-Practice (PIP) Activity to help identify and address gaps in your practice treating patients with OUD.
Please email email@example.com with subject “MAT” to be added to a MAT information list for further information or to provide feedback on your experience.
Substance Abuse and Mental Health Administration (SAMHSA)
Additional Resources and Information
The Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) Act for Patients Communities Act was enacted into law on October 24, 2018. Within section 3201, this Act expands earlier legislation in the 2016 Comprehensive Addiction and Recovery Act (CARA) to include Certified Registered Nurse Anesthetists (CRNAs) among providers able to prescribe medication-assisted treatment (MAT) to individuals suffering from opioid addiction.
- AANA letter to HHS: AANA Supports Increased Patient Assess to Safe, Responsible Use of MAT, June 25, 2019
- AANA Opioid Crisis Resources
- AANA Press Release, October 24, 2018
Agency for Healthcare Research and Quality (AHRQ)
Medication-Assisted Treatment for Opioid Use Disorder Playbook, a practical guidance tool for implementing MAT in primary care and other ambulatory care settings
U.S. Food & Drug Administration (FDA)
- FDA announces public health emergency prioritization of ANDAs for drug products for the emergency treatment of opioid overdose
- Statement from Commissioner Scott Gottlieb, M.D., on 2019 policy and regulatory agenda for continued action to forcefully address the tragic epidemic of opioid abuse, February 26, 2019
- Statement from Commissioner Scott Gottlieb, M.D., on new regulatory authorities as part of the newly enacted SUPPORT for Patients and Communities Act, October 24, 2018
U.S. Department of Health & Human Services (HHS) Office of the Surgeon General
National Academies of Sciences, Engineering and Medicine
National Conference of State Legislatures (NCSL)
- NCSL Scope of Practice Policy map indicating the number of nurse practitioners (NPs) and physician assistants (PAs) prescribing buprenorphine by state, based on SAMSHA waivers issued: Behavioral Health Providers Overview
National Institutes of Health (NIH)
- Mission: To advance excellence in nursing care for the prevention and treatment of addictions for diverse populations across all practice setting through advocacy, collaboration, education, research and policy development.
- Addiction Nurses Save Lives
Anesthesia Considerations for Patients on MAT, in Active State of Opioid Use Disorder, or Opioid Therapy
- AANA Practice Considerations: Analgesia and Anesthesia for the Substance Use Disorder Patient (2019)
- AANA Journal article: The Opioid Crisis and the Certified Registered Nurse Anesthetists: Caring for Patients receiving Medication-Assisted Treatment June 2019 Guest Editorial
- American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Perioperative Management of Patients on Preoperative Opioid Therapy, Anesthesia Analgesia