Suboxone Prescribing Requirements & Guidelines

Suboxone contains buprenorphine, which is a controlled substance per federal laws. To prescribe this medication, doctors must have approval from regulatory agencies. This process is easier than it once was.

Before December 29, 2022, doctors needed a so-called “X-waiver” to prescribe medications with buprenorphine. With that requirement eliminated, doctors need a current Drug Enforcement Administration (DEA) registration to prescribe Suboxone.[1]

What Are the Requirements for Doctors to Prescribe Suboxone?

All doctors with a current Drug Enforcement Administration (DEA) registration with Schedule III authority can prescribe medications for opioid use disorder (OUD) if permitted by state law.[4]

The “Schedule III authority” in this rule refers to drug classifications. Buprenorphine in Suboxone is considered a Schedule III controlled drug by the DEA, and doctors must apply for a license to administer these drugs. If doctors have this approval, they can prescribe Suboxone. 
After June 27, 2023, doctors asking for new DEA licenses or renewing old ones must meet one of these requirements:[4]

• A total of eight hours of training on OUD
• Board certification in addiction medicine 
• Graduation within five years from a program that included OUD curriculum lasting at least eight hours

Can Suboxone Be Prescribed via Telehealth?

Doctors can prescribe Suboxone via telemedicine. The DEA is examining the practice carefully and researched tightening rules in the spring of 2023. After public outcry, rule changes were suspended.[5]

Under current rules, you can’t get a Suboxone prescription online. But you can use your computer to meet with a doctor licensed to provide telehealth in your state and get a prescription for Suboxone. Your appointment runs just like an in-person version would, but it’s conducted from the privacy and security of your own home. You can fill your prescription at a pharmacy that carries Suboxone.

Suboxone and insurance coverage for telehealth is straightforward. Many companies offer telehealth appointment benefits, allowing you to meet with professionals via your computer or phone.

Who Is Eligible for Suboxone Treatment?

Doctors can prescribe Suboxone via telemedicine. The DEA is examining the practice carefully and researched tightening rules in the spring of 2023. After public outcry, rule changes were suspended.[5]

Under current rules, you can’t get a Suboxone prescription online. But you can use your computer to meet with a doctor licensed to provide telehealth in your state and get a prescription for Suboxone. Your appointment runs just like an in-person version would, but it’s conducted from the privacy and security of your own home. You can fill your prescription at a pharmacy that carries Suboxone. 

Suboxone and insurance coverage for telehealth is straightforward. Many companies offer telehealth appointment benefits, allowing you to meet with professionals via your computer or phone.

What Was the X-Waiver Requirement for Suboxone?

The X-waiver was part of the Drug Addiction Treatment Act of 2000. Rules were designed to ensure that buprenorphine products were administered properly, even if patients took the drugs home to use them. 

To get an X-waiver, doctors had to meet the following requirements:

• Complete OUD trainings
• Work in treatment facilities made for OUD recovery 
• Treat a specified amount of patients 
• Apply for special paperwork 
• Mark buprenorphine prescriptions with an X-waiver license number

Experts considered this a time-consuming process that discouraged doctors from prescribing the drug. As a result, just 5% of medical providers were licensed to prescribe buprenorphine products, and large portions of the country had no doctors with X-waivers at all.[6]

When France eliminated its X-waiver rules, opioid overdose deaths dropped by 79% over three years.

Source[7]

Benefits of Removing the X-Waiver Requirement

The X-waiver was made to ensure that doctors administered medications like Suboxone safely. Instead, it may have caused harm.

Extra training suggests that doctors must treat their OUD patients in a different way than other patients. Each class adds to the stigma surrounding addiction, which could mean that doctors provide these people with a lesser class of care.

The waiver’s hassles and limits also meant that fewer doctors could treat patients in need. They might be able to diagnose a patient with OUD, but they wouldn’t be able to administer the medications that could help. In some parts of the country, no doctors were available to help people with medications like Suboxone.

How Can You Get a Prescription for Suboxone?

Patients can get a prescription for Suboxone from a doctor with DEA Schedule III authority. This doctor can work in a clinic, hospital, online business or other medical facility. The DEA license is the important part. 

Online Suboxone doctors can prescribe Suboxone. In-person doctors can too. These medical professionals aren’t required to apply for a federal X-waiver, as that program no longer exists.

Who Is Eligible for Suboxone Treatment?

If you have OUD, Suboxone will be a good medication choice to prevent cravings, withdrawal symptoms and overdose. 

You meet Suboxone treatment eligibility if you are the following:

• Pregnant: Suboxone is safe to use while pregnant, and you can keep taking your medication after you have the baby too.
• Older: Patients must be at least 16 years old to take Suboxone, although there may be exceptions to this in cases where patients are experiencing addiction at a young age. 
• Meeting criteria for an OUD: You must meet the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for OUD.
• Stable: Your team must ensure that you have access to housing, safe living conditions and enough social support to help you be successful in your recovery. 

Who Is Ineligible for Suboxone Treatment?

Some people aren’t right for Suboxone treatment. If you meet some conditions, your doctor might look for another treatment type for you. 

People who are probably not ideal candidates for Suboxone are any of the following:

• Struggling with severe mental illness: If you have serious and uncontrolled/untreated psychiatric problems (such as thoughts of suicide or active psychosis), it may not be appropriate to initiate Suboxone treatment. 
• Have alcohol use disorder: Alcohol acts as a depressant, slowing your body’s central nervous system. When Suboxone and alcohol mix, there is an increased risk of sedation, difficulty breathing, overdose and fatality.[8] 
• Polypharmacy/misuse of other medications: If you misuse benzodiazepines, sedatives or hypnotics, Suboxone treatment may have to be postponed. 
• Allergic: Patients should not be prescribed Suboxone if they have a known allergy or hypersensitivity to buprenorphine. However, this is quite rare.

What to Expect When Starting Suboxone Treatment

The best time to start Suboxone is when you are experiencing withdrawal symptoms, usually somewhere between 12 to 24 hours after using opioids. Chills, nausea, pain and headaches are all signs that your body is ready to start Suboxone.

In some programs, you’ll start your medication in a supervised setting. At others, you may be counseled on how to take your first dose in the comfort of your own home. This is usually a decision you and your doctor can make together. 

Going forward, most patients have monthly visits to check in and refill Suboxone prescriptions. 

How Long Will Suboxone Treatment Last?

Each person is unique, as is their treatment plan. Some people use Suboxone for just a few months, while others may use it indefinitely.

Opioid use disorder is a chronic condition, and research shows that patients who stay on Suboxone long term are more likely to be opioid-free long term as well.[9]

Conversely, studies demonstrate that within one month of stopping treatment, more than 50% of patients relapse to illicit opioid use.[10]

It is safe to stay on Suboxone for many years, particularly if a patient feels it is helping them to sustain abstinence. However, if you desire to taper off Suboxone, consult with your medical provider to slowly taper your dose, as this will help prevent withdrawal symptoms.

Learn More About Suboxone Treatment

If you have questions about opioids, opioid use disorder, treatments or other Suboxone-related questions, browse through our Suboxone FAQs. To learn whether telemedicine Suboxone treatment is a good fit for you, call us at 1-844-943-2514 or schedule an appointment here.