Buprenorphine as an NP Where the State Still Wants a Physician

What the 2023 waiver repeal changed for a nurse practitioner

It removed the federal permission slip and left the state one standing. Section 1262 of the Consolidated Appropriations Act, 2023 ended the requirement to file a Notice of Intent, the DATA waiver, before prescribing buprenorphine for opioid use disorder, and SAMHSA stopped accepting waiver applications 1Ref 1Substance Abuse and Mental Health Services Administration (SAMHSA) (2026).Waiver Elimination (MAT Act).The federal layer only: that Section 1262 of the Consolidated Appropriations Act, 2023 ended the Notice of Intent (DATA waiver) requirement along with the patient limits, discipline restrictions and counseling certification, and SAMHSA's own conditional sentence that a practitioner with a current DEA registration including Schedule III authority may prescribe buprenorphine for opioid use disorder if permitted by applicable state law.. The patient limits went with it, along with the discipline restrictions and the certification about providing counseling 1Ref 1Substance Abuse and Mental Health Services Administration (SAMHSA) (2026).Waiver Elimination (MAT Act).The federal layer only: that Section 1262 of the Consolidated Appropriations Act, 2023 ended the Notice of Intent (DATA waiver) requirement along with the patient limits, discipline restrictions and counseling certification, and SAMHSA's own conditional sentence that a practitioner with a current DEA registration including Schedule III authority may prescribe buprenorphine for opioid use disorder if permitted by applicable state law..

What replaced the waiver is a sentence with a condition on the end of it. SAMHSA's wording is that all practitioners who have a current DEA registration that includes Schedule III authority may now prescribe buprenorphine for opioid use disorder in their practice "if permitted by applicable state law" 1Ref 1Substance Abuse and Mental Health Services Administration (SAMHSA) (2026).Waiver Elimination (MAT Act).The federal layer only: that Section 1262 of the Consolidated Appropriations Act, 2023 ended the Notice of Intent (DATA waiver) requirement along with the patient limits, discipline restrictions and counseling certification, and SAMHSA's own conditional sentence that a practitioner with a current DEA registration including Schedule III authority may prescribe buprenorphine for opioid use disorder if permitted by applicable state law.. Everything a nurse practitioner in a collaborative or supervisory state needs to know sits in that last clause, and no federal page will resolve it.

The repeal removed a federal step. The state step underneath it is untouched.

Where a physician-involvement rule attaches

To the state's own prescriptive authority, and almost never to buprenorphine by name. A state that requires physician involvement is describing how a nurse practitioner prescribes anything: through a collaborative agreement or protocol, a standard care arrangement, a furnishing number, a set of standardized procedures. Buprenorphine enters that structure as a Schedule III controlled substance and inherits whatever the structure already says about controlled substances.

The vocabulary is worth having before you call the board. The American Association of Nurse Practitioners sorts states into three groups and publishes plain definitions of them: a reduced-practice state is one whose law requires a career-long regulated collaborative agreement with another health provider for the NP to provide patient care, or limits the setting of one or more elements of practice, and a restricted-practice state requires career-long supervision 2Ref 2American Association of Nurse Practitioners (2026).State Practice Environment.AANP's own definitions of the practice-environment categories, used here as vocabulary for the lookup: that a reduced-practice state requires a career-long regulated collaborative agreement with another health provider or limits an element of practice by setting, and a restricted-practice state requires career-long supervision. Cited as a classification, never as any state's law.. That map is a classification rather than a statute. It tells you which question to ask, and your board tells you the answer.

The same board rulebook usually answers the neighboring questions in one sitting, which is worth doing once instead of four times: required not-a-physician signage, self-prescribing and family prescribing, and which schedules your prescriptive authority reaches at all.

The lookup that settles it for your state

Four moves, in this order, and your board of nursing answers three of them. Start with the statute or rule that grants prescriptive authority to a nurse practitioner in your state, then the schedules that authority reaches, then the document the state makes you hold, then the terms inside the copy you already signed. A buprenorphine question that stalls almost always stalls on the last two.

1. Find the prescriptive-authority rule itself on the board's site, by its statute or rule number, and read the rule rather than the summary page linking to it. 2. Check which schedules the authority reaches. Several states handle Schedule II on its own track, and state caps on Schedule II authority tell you nothing about Schedule III, which is where buprenorphine sits. 3. Identify the instrument your state uses and who has to sign it: a collaborative agreement, a standard care arrangement, a protocol, a set of standardized procedures. 4. Read your own signed copy for drug-category limits, chart-review duties, and any physician co-signature on NP notes the arrangement imposes on top of the state minimum.

Then call the board with the citation in hand. A question that names your state's rule number and Schedule III gets a usable answer; a general one gets a link back to the page you have already read.

Two states, two mechanics

Ohio and California both keep a physician in the picture and reach it through different instruments, which is why a national answer to this question does not exist. Ohio builds it around a signed arrangement between named people. California builds it around a number the board issues and a set of procedures written with a supervising physician. Read either as an illustration of the shape, never as your rule.

In Ohio, a certified nurse practitioner may practice only in accordance with a standard care arrangement entered into with each physician or podiatrist with whom the nurse collaborates, and no physician or podiatrist may collaborate at the same time with more than five nurses in the prescribing component 3Ref 3Ohio General Assembly (2026).Section 4723.431 | Standard care arrangements..Ohio only: that a certified nurse practitioner may practice only in accordance with a standard care arrangement entered into with each physician or podiatrist with whom the nurse collaborates, and that no physician or podiatrist may collaborate at the same time with more than five nurses in the prescribing component.. That cap has an operational edge: a physician already collaborating at the limit cannot sign for you, whatever the two of you have agreed.

California runs on a furnishing number. The Board of Registered Nursing issues it to let an NP order or furnish drugs and devices using approved standardized procedures, developed with the supervising physician and surgeon 4Ref 4California Board of Registered Nursing (2026).Nurse Practitioner — practice information, furnishing numbers and Schedule II requirements.California only: that the Board of Registered Nursing issues a furnishing number allowing an NP to order or furnish drugs and devices under approved standardized procedures developed with the supervising physician and surgeon, and that the page states a DEA registration prerequisite in its Schedule II sentence while saying nothing about Schedule III.. The board's practice page carries a DEA registration prerequisite in its Schedule II sentence and does not address Schedule III at all. A California NP working out where buprenorphine sits asks the board directly instead of reading an answer out of that page.

Ohio's rule tells you nothing about California's, and neither tells you about yours.

What the collaboration document has to carry

More than two signatures, and the required contents are often set by rule rather than left to the two of you. Ohio's board rule is a useful specimen. A standard care arrangement there must carry the signatures, a quality-assurance and chart-review reference, criteria for referral, a consultation process, a plan for coverage during absence and emergencies, dispute resolution, provisions on the state prescription monitoring system, and three-year retention of superseded arrangements 5Ref 5Ohio Board of Nursing (2026).Rule 4723-8-04 | Standard care arrangement for a certified nurse-midwife, certified nurse practitioner, and clinical nurse specialist..Ohio only: the mandatory contents the board rule requires a standard care arrangement to carry, used here as a worked specimen of what such a document has to include: signatures, a quality-assurance and chart-review reference, criteria for referral, a consultation process, a plan for coverage during absence and emergencies, dispute resolution, OARRS provisions, and three-year retention of superseded arrangements..

Read that list as a price sheet. Each line is work somebody performs every month, and together they are the real content of a collaborating physician's monthly fee: chart review at some cadence, availability for consultation, coverage while you are away, and a name on a document the board can ask to see. What that costs is a negotiation, and no figure worth citing anchors it, so ask what the fee buys in those terms before anyone names a number.

Ask one more question before signing, because it is expensive to discover later: whether the physician will collaborate on opioid use disorder care at all. A state rule can permit the prescribing while the person whose signature you depend on declines it.

The training attestation that survived the repeal

One federal requirement replaced the waiver, and it is an attestation rather than a program. The MATE Act asks DEA-registered practitioners, other than those solely practicing veterinary medicine, to attest to at least eight hours of one-time training on treating and managing patients with substance use disorders, at their first new or renewal registration application on or after June 27, 2023 6Ref 6U.S. Drug Enforcement Administration, Diversion Control Division (2023).Opioid Use Disorder – MATE Act Q&A.The federal training attestation that survived waiver elimination: the one-time eight-hour requirement, its application to DEA-registered practitioners other than those solely practicing veterinary medicine, the trigger at a new or renewal registration application on or after June 27, 2023, the advanced-practice-nursing graduate pathway, that prior DATA-Waiver training counts, and that no certificate is submitted to DEA while the practitioner retains the record..

Prior DATA-waiver training counts toward the requirement. Some graduates of an accredited advanced-practice nursing program are covered by a separate pathway, and it carries its own conditions, so check the DEA's questions and answers for which one you fall under before paying for a course. And nothing is submitted to DEA with the application, which makes the certificate yours to retain rather than yours to file 6Ref 6U.S. Drug Enforcement Administration, Diversion Control Division (2023).Opioid Use Disorder – MATE Act Q&A.The federal training attestation that survived waiver elimination: the one-time eight-hour requirement, its application to DEA-registered practitioners other than those solely practicing veterinary medicine, the trigger at a new or renewal registration application on or after June 27, 2023, the advanced-practice-nursing graduate pathway, that prior DATA-Waiver training counts, and that no certificate is submitted to DEA while the practitioner retains the record..

This one is federal and uniform. It is the only part of the answer that does not change when you cross a state line.

Starting a patient by telemedicine, as read on September 1, 2026

A federal pathway exists to initiate buprenorphine for a patient never examined in person, by audio-visual or audio-only telemedicine, and it carries two conditions and a ceiling. Check the prescription drug monitoring system in the state where the patient is located before prescribing, document the date and time you checked it, and prescribe no more than a total of six months by that route before an in-person visit or another mechanism DEA determines 7Ref 7Substance Abuse and Mental Health Services Administration (SAMHSA) (2025).Buprenorphine Telemedicine Prescribing: Questions and Answers.The federal telemedicine-initiation pathway only, stamped as read on 2026-09-01: initiation by audio-visual or audio-only telemedicine for a patient never examined in person, the check of the prescription drug monitoring program in the state where the patient is located with the date and time documented, and the six-month total ceiling by that route. Also cited for the fact that the page states no state-law overlay..

This is the most volatile rule on the page, which is why it is stamped with the date it was read. SAMHSA's questions and answers describe the federal pathway and state no overlay from any state's law 7Ref 7Substance Abuse and Mental Health Services Administration (SAMHSA) (2025).Buprenorphine Telemedicine Prescribing: Questions and Answers.The federal telemedicine-initiation pathway only, stamped as read on 2026-09-01: initiation by audio-visual or audio-only telemedicine for a patient never examined in person, the check of the prescription drug monitoring program in the state where the patient is located with the date and time documented, and the six-month total ceiling by that route. Also cited for the fact that the page states no state-law overlay., so a state telehealth statute, a state monitoring-program rule and your own physician-involvement requirement all sit on top of it and can be stricter. Nothing in the federal pathway lifts a state requirement, and none of it should be read as state permission.

Re-read SAMHSA's page before you rely on it, and record the date you read it in whatever policy you write from it.