A Comprehensive Guide to the MATE Act and the Elimination of Waiver

Elimination of X-Waiver and Training Requirements for New MATE ACT 

As a healthcare provider, you've probably heard about the Medication Access and Training Expansion (MATE) Act but may be unclear about precisely what it means for you. This comprehensive overview can help you better understand it—and what you need to do to be compliant.  

In place since June 2023, the MATE Act is a federal regulation that requires that Drug Enforcement Administration (DEA)-registered physicians and practitioners complete training on treating and managing patients with opioid or other substance use disorders.   

The Consolidated Appropriations Act of 2023 (CAA) modified the Controlled Substances Act and affected all medical practitioners who can prescribe, excluding veterinarians. This amendment had three significant impacts: 

1. Prescribing medication, such as buprenorphine, to treat patients with opioid use disorder (OUD) previously required an X-waiver, also known as a DATA-waiver. But now, practitioners need only a standard DEA registration number to prescribe OUD medications like any other prescription. 

2. All practitioners who hold a current DEA registration, including Schedule III authority, are now allowed to prescribe buprenorphine for OUD as permitted by your applicable state law. However, please note that your state requirements may differ from the federal law. 

3. Eliminates federal requirements for counseling provision, patient limits, and discipline restrictions. There is no longer a requirement to report your annual patient load. 

Immediately upon signing the Consolidation Appropriations Act of 2023, the number of clinicians who can prescribe buprenorphine jumped from 130,000 to 1.8 million. This reduction of barriers to initiating and expanding treatment goes a long way to addressing the US opioid crisis. 

Discover the Top Three Benefits of the MATE Act for Your Patients 

The MATE Act guarantees that every DEA-approved medication prescriber has a basic understanding of preventing addiction and how to diagnose and treat all patients with substance use disorders. 

1. Improved Patient Care: By providing healthcare professionals with the knowledge and skills needed to treat their patients with opioid or other related substance use disorders, the MATE Act helps ensure that all patients receive the appropriate care and support that they need and will improve healthcare providers' ability to identify and treat substance use disorders.  

2. Standardized Training: The MATE Act standardizes substance use disorder training to ensure that all prescribers of different addictive medications have the appropriate knowledge and training in all evidence-based addiction prevention and treatment.  

3. Enhanced Pain Management: The MATE Act aims to improve pain management by educating all providers on appropriate treatment for all patients with or who are at risk of developing opioid or other substance use disorders. 

Answering Your Most Pressing MATE Act Questions  

What are the MATE Act learning objectives? 

Upon completion of the educational activity, participants should be able to: 

1. Distinguish appropriate actions for prescribers and dispensers related to the federal laws regarding prescription practices for controlled substances via in-person and telemedicine settings. 

2. Explain the appropriate use for and application of opioids and non-opioids in clinical practice, including initiation, continuation/discontinuation, forced opioid tapers, and dose escalation. 

3. Identify appropriate areas of clinical assessment and evaluation of treatment failure, including how to adequately analyze risks and benefits of specific dosing regimens. 

4. Integrate workflows that foster responsible opioid prescribing practices, incorporate appropriate risk mitigation strategies, and improve the informed consent process between clinicians and patients. 

5. Outline best practices regarding implementing tools for diversion and surveillance of controlled substances. 

Who needs to complete the training?  

All DEA-registered practitioners, except veterinarians, who prescribe any Schedule II – V controlled medications. 

This means that anyone who prescribes controlled substances and treats patients with opioid or other substance use disorders must complete MATE Act training by your next scheduled DEA registration submission or at the time of your initial registration. 

Practitioners can satisfy this training by engaging in a total of eight hours of training on the treatment and management of patients with opioid or other substance use disorders from the accredited group, such as PAINWeek.  

Which practitioners are deemed to have already satisfied these new requirements? 

The following practitioners are deemed to have satisfied this training:  

1. All practitioners who are board-certified in addiction medicine or addiction psychiatry from the American Board of Medical Specialties, American Board of Addiction Medicine, or American Osteopathic Association.

2. All practitioners that graduated in good standing from a medical (allopathic or osteopathic), dental, physician assistant, or advanced practice nursing school in the US within five years of June 27, 2023, and successfully completed at least eight hours of training on:  

1. Treating and managing patients with opioid or other substance use disorders, including the appropriate clinical use of all drugs approved by the Food and Drug Administration for the treatment of a substance use disorder or.

2. Safe pharmacological management of dental pain and screening, brief intervention, and referral for appropriate treatment of patients with or at risk of developing opioid and other substance use disorders.  

How many hours of CME are required, and in what format?  

It's a one-time, eight-hour training that must be completed by your next scheduled DEA registration submission or at the time of your initial registration. Training can include classroom settings, seminars at professional conferences, or online if provided by a qualified organization, such as PAINWeek.     

Do I need to complete the eight hours all at once?  

The required eight hours can be completed in one session or multiple sessions.  

Will this be a yearly requirement? 

The MATE Act is a one-time requirement. Once you have completed the training, you don't need to repeat the training for future registration renewals.   

How will I report satisfying this new training requirement? 

Beginning on June 27, 2023, you will be required to check a box on your online DEA registration form—regardless of whether a registrant is completing their initial registration application or renewing their registration—affirming that you have completed the new training requirement. 

Are there any limitations on the number of patients with OUD that a practitioner may treat with buprenorphine? 

After the enactment of the CAA, there are no longer limitations on the number of patients with OUD that a practitioner may treat with buprenorphine (Please note this change applies under federal law, and you must check your state's requirements).  

What is the deadline for satisfying this new training requirement? 

1. The deadline for satisfying this new training requirement is the date of your next scheduled DEA registration submission—regardless of whether it is an initial registration or a renewal registration—on or after June 27, 2023. 

2. This one-time training requirement affirmation will not be a part of future registration renewals. 

What if I completed relevant training prior to the passage of CAA? 

Past training on the treatment and management of patients with opioid or other substance use disorders counts toward this requirement. In other words, if you received relevant training from an accredited group, such as PAINWeek, before the enactment of this new training obligation on December 29, 2022, that training count towards the eight-hour training requirement. 

What if I took the training to obtain an X-waiver and prescribed buprenorphine for opioid use disorder? 

Past X-Waiver or DATA-Waiver trainings count towards a practitioner’s eight-hour training requirement. 

PAINWeek Offers Training to Fulfill the MATE Act Requirement 

PAINWeek's MATE Act Module will enable you to complete your training on substance use disorders. The required eight hours of coursework are available online, on any device, and at your convenience. PAINWeek's expert faculty have designed these courses to enable you to become fully compliant with MATE Act requirements and to strengthen your ability to effectively treat patients with substance abuse disorders.  

Click here to learn more about The MATE Act Module. 

Explore PAINWeek resources! 

Live, digital, or print, PAINWeek provides education and insight 365 days/year! 

PAINWeek Conference 2024–The #1 annual pain conference in the nation delivers over 75 hours of CME content in cutting-edge pain science in the City of Entertainment: Las Vegas! 

PAINWeek Media–Explore hundreds of hours of pain education resources, from 60-second expert insights to on-demand expert opinion video interviews to the PAINWeek podcast. 

PAINWeek Education–On-demand instant digital access to certified educational activities so you can earn CMEs on your schedule. 

Additional Resources 

1. MATE Act Training Requirements (June 2023) 

2. SAMHSA DEA Webinar: The Consolidated Appropriations Act of 2023 

3. SAMHSA Buprenorphine Quick Start Guide (PDF) 

4. SAMHSA Buprenorphine Pocket Guide (PDF) 

5. SAMHSA Guide to Substance Abuse Services for Primary Care Clinicians 

6. DEA Opioid Use Disorder MATE Act (FAQ) 

7. DEA MATE Training Letter  

8. DEA Buprenorphine (FAQ) 

Other Categories:

• buprenorphine

• misuse

• opioid use disorder (OUD)

• substance use disorder (SUD)