Special Circumstances for Providing Buprenorphine

Learn about circumstances where physicians or other medical personnel can provide buprenorphine without a waiver.

Several federal laws and regulations permit physicians and other medical personal to administer buprenorphine to patients with opioid dependencies without a buprenorphine waiver.

Buprenorphine for Conditions Other than Opioid Addiction

Neither the Controlled Substances Act, as amended by DATA 2000, nor Drug Enforcement Administration (DEA) regulations Administering or Dispensing Narcotic Drugs, 21 Code of Federal Regulations (CFR) 1306.07 impose any limitations on a physician or other authorized hospital staff to maintain or detoxify a person with buprenorphine as an incidental adjunct to medical or surgical conditions other than opioid dependency.

A patient with an opioid dependency who is admitted to a hospital for a primary medical problem other than opioid dependency, such as myocardial infarction, may be administered opioid agonist medications such as methadone and buprenorphine to prevent opioid withdrawal that would complicate the primary medical problem.

A DATA 2000 waiver is not required for practitioners in order to administer or dispense buprenorphine or methadone in this circumstance. It is good practice, however, for the admitting physician to consult with the patient's substance misuse treatment provider, when possible, to obtain treatment history.

Buprenorphine in Medical Emergencies

Under the Narcotic Addiction Treatment Act – 1974 (PDF | 437 KB), all practitioners who use narcotic drugs for treating opiate addiction must obtain a separate registration under 21 U.S.C. Section 823(g)(1) or a DATA 2000 Waiver under 21 U.S.C. Section 823(g)(2).

However, according to DEA, an exception to the registration requirement, known as the “three-day rule” (Title 21, Code of Federal Regulations, Part 1306.07(b)), allows a practitioner who is not separately registered as a narcotic treatment program or certified as a waivered DATA 2000 physician, to administer (but not prescribe) narcotic drugs to a patient for the purpose of relieving acute withdrawal symptoms while arranging for the patient’s referral for treatment, under the following conditions:

  • Not more than one day’s medication may be administered or given to a patient at one time
  • Treatment may not be carried out for more than 72 hours
  • The 72-hour period cannot be renewed or extended

The intent of regulation 21 Code of Federal Regulations (CFR) 1306.07(b) is to provide practitioners with flexibility in emergency situations where they may be confronted with a patient undergoing withdrawal. In such emergencies, it is impractical to require practitioners to obtain a separate registration. The 72-hour exception offers an opioid dependent individual relief from experiencing acute withdrawal symptoms, while the physician arranges placement in a maintenance or detoxification treatment program.

This provision was established to augment, not to circumvent, the separate registration requirement. The three-day (72-hour) emergency exception cannot be renewed or extended.

Learn more about this DEA rule.

Last Updated: 03/04/2019