March 30, 2023

SAMHSA and the DEA Release Guidance Regarding New Educational Requirements around the Treatment of Substance Use Disorder

Last week, I mentioned that we were waiting for the Drug Enforcement Administration (DEA) and the Substance Abuse and Mental Health Services Administration (SAMHSA) to release guidance on a mandatory 8-hour training requirement on substance use disorder (SUD) treatment that every practitioner will need to complete in order to receive or renew their DEA license. Well, that guidance has now been released!

Specifically, SAMHSA has released recommendations and the DEA has issued specific guidance on how practitioners can meet this requirement. The requirement stems from a provision that was included in the major omnibus bill that Congress passed at the end of last year. This is the same legislation that repealed the X-waiver requirement for prescribing medications for opioid use disorder (OUD). Although repealing the X-waiver was a top legislative priority, stakeholders convinced Congress that additional education was also necessary to promote best practices in the treatment of OUD and SUD more generally and to encourage more practitioners to prescribe buprenorphine. ACEP did not support this mandatory educational requirement, but now that it’s the law, it could provide an opportunity for those who have not received any education around OUD treatment to get some training.

Fortunately, it appears that the DEA and SAMHSA are making the requirement extremely flexible. Basically, in order to receive or renew your DEA license starting on June 27 of this year, you will have to check a box on your application showing that you received 8 hours of training on SUD treatment. If you have a DEA license already, this doesn’t mean you have to complete the training by June 27. It means that, starting June 27, you have to complete the requirement (if you haven’t already) by the next time you are required to renew your DEA license (you usually renew your DEA license every three years). Thus, if you just renewed your license and haven’t met the requirement yet, you have a few years to do so.

So, what does this new educational requirement entail? SAMHSA provides some detailed recommendations of what the training can include based on a review of existing literature on SUD-related education. The elements that SAMHSA recommends provide “a basic overview of SUD identification, management and evidence-based care, as well as pain management.” However, SAMHSA’s recommendations are just that: recommendations. They are not required elements and do not “establish legally binding standards for substance use disorder curricula.” However, they are still useful to look through, as they present the agency’s vision of what a successful educational curriculum should look like.

There are other important considerations for this 8 hours of training that actually will make it easier for practitioners to complete:

  • Exemptions: Those who are board-certified in addiction medicine or addiction psychiatry from the American Board of Medical Specialties, American Board of Addiction Medicine, or the American Osteopathic Association are exempt from the requirement. In addition, practitioners who graduated within five years and in good standing from a medical, advanced practice nursing, or physician assistant school in the United States that included successful completion of an opioid or other substance use disorder curriculum of at least 8 hours are also exempt.
  • X-Waiver training counts: Those of you who did 8 hours of classroom training to receive an X-waiver have already met the new educational requirement!
  • In fact, any previous training counts: If you received any other training related to the treatment of patients with OUD or SUD that counts as well! In other words, the training is retrospective and could have occurred any time in the past.
  • 8 hours doesn’t have to be at once: You don’t have to sit through one 8-hour session—the requirement can be satisfied through cumulative CME hours.
  • Flexibility in type of training: Trainings can occur in a variety of formats, including classroom settings, seminars at professional society meetings, or virtual offerings.

I’ve also saved the best news for last. If you still need to complete 8 hours of training (you don’t fit into the exemption or haven’t received previous training), ACEP CAN HELP! Organizations accredited by the Accreditation Council for Continuing Medical Education (ACCME) or the Commission for Continuing Education Provider Recognition (CCEPR) can provide training— and ACEP is accredited by the ACCME. We already have a host of trainings available including:

ACEP has also partnered with the American Board of Emergency Medicine (ABEM), the Council of Residency Directors in Emergency Medicine (CORD), and the Emergency Medicine Residents' Association (EMRA) in the development of a SUD curriculum for emergency medicine residency programs. The free, open access curriculum is comprised of eight approximately 20-minute modules covering: Introduction to Opioids, Treatment and Management of Opioid Use Disorder, Alcohol and Benzodiazepines, Tobacco, Cannabis and Vaping, Stimulants, and Special Populations, and is available in both PowerPoint and video format.

Finally, I have confirmed with the DEA that all you need to do to show that you met the training requirement (or are exempt) is attest to it. This means clicking a box on your DEA license application when you receive or renew your DEA license. You will not be required to show any formal proof that you met the requirement, and you will not be required to retain any documentation. Further, medical school graduates will do the same thing: attest that they have had 8 hours of total training within the last five years. Medical schools will not need to attest to their curricula.

In all, the DEA and SAMHSA seemed to have gone out of their way to make this requirement as easy to meet as possible. However, despite the flexibility they provide (including not having to show the DEA any proof that you met the requirement), it definitely can’t hurt to double check that you receive eligible trainings and to keep a record of your trainings if possible. While I don’t foresee SAMHSA and the DEA issuing more stringent guidance going forward, it’s always good to be a diligent as possible when it comes to adhering to regulatory requirements!

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