Congress to permit “physicians with certain qualifications to treat
opioid addiction with Schedule III, IV, and V narcotic medications
that have been specifically approved by the FDA for that indication.”
(SAMHSA). Such medications may be prescribed or dispensed by
waivered physicians in treatment settings other than the traditional
Opioid Treatment Program, namely the traditional methadone
clinic.
Qualifications for a DATA waiver include:
1. Holding a DEA license.
2. Notification and application to CSAT (Center for Substance
Abuse Treatment) a part of SAMHSA.
3. Assignment by DEA of a special Identification number (“X”
number) to be on all buprenorphine prescriptions.
4. And any one of the followingA. Hold subspecialty Board certification in Addiction Psychiatry.
B. Hold addiction certification from the American Society
of Addiction Medicine (ASAM).
C. Hold subspecialty Board certification in addiction medicine from the America Osteopathic Association (AOA).
D. Completed an 8 hour training provided by ASAM,
American Association of Addiction Psychiatry (AAAP),
AOA, American Psychiatric Association (APA).
E. Participated as an investigator in one or more clinical
trials leading to approval of a narcotic drug Schedule
III, IV, or V for maintenance or detoxification treatment.
F. Has other training or experience as the State Medical
Board considers to demonstrate the ability of the physician to treat and manage opioid-addicted patients.
G. The physician has such other training or experience to
demonstrate the ability to treat and manage opioid-addicted patients.
Fulfillment of these requirements permits physicians to acquire a
DATA waiver and the ability to treat a maximum of 30 patients in
the first year of practice and then, after notification to and approval
by CSAT, the ability to treat a maximum of 100 patients.
Currently courses are available through ASAM, AAAP, APA, and
AOA websites for certification. Typical charge for the online course
is $200 although free courses may be available. National meetings by
all these organizations also provide onsite trainings for certification
as a part of the usual registration.
mental health and substance use disorder benefits are no more
restrictive than the predominant requirements or limitations applied
to substantially all medical/surgical benefits (US Department of
Labor Fact Sheet). This however does not apply to Medicare or
Medicaid programs.
As of 2010 twenty five states provided Medicaid coverage for
methadone treatment. Kentucky is not one of them. Buprenorphine
coverage as well has been quite limited by all managed care
organization with barriers including prior authorization, dose limits,
and length of treatment limits. With more attention to parity there
does seem to be improvement in coverage but the barriers still exist
and reimbursement is poor. In 2014 the Kentucky Cabinet for Health
and Family Services created the new entity of Behavioral Health
Services Organization (BHSO) to address treatment in behavioral
health and addiction. This provides a framework for provision of
services and reimbursement to licensed facilities. Yet the majority of
providers in Kentucky operate on a cash-only basis, thus restricting
access. Prescriptions are typically covered. Medicaid providers
must accept assignment for reimbursement if prescriptions are to
be covered.
THE FUTURE
Opiate Agonist Treatment works. Using medicat