Skip to Main Content

MSUD Training for Nurses

The Medications for Substance Use Disorders training for nurses is currently closed. Renewal and updating of this course are pending external funding.

In the Meantime:

Here’s some helpful information informed by APNA subject matter experts.

Expand All

While this course is unavailable, where can I find the 8-hour training I need?

What does a PMH-APRN need to prescribe buprenorphine for opioid use disorder (OUD)?

  • To prescribe buprenorphine for opioid use disorder (OUD), you no longer need a federal DATA-Waiver (X-waiver). Providers need an active, standard DEA registration that includes Schedule III authority, completion of a one-time 8-hour MATE Act training on substance use disorders, and compliance with specific state-level laws.

How do I talk with patients about medications for opioid use disorder (MOUD) without increasing shame or resistance?

Key Messages:

  •  Lead with curiosity, not judgment. Ask permission before discussing treatment.
    • “Would it be okay if we talked about some treatment options that have helped many people?”
  • Use person-centered, non-stigmatizing language.
    • Say “person with opioid use disorder” instead of “addict.”
    • Say “return to use” instead of “relapse.”
    • Avoid terms like “clean” or “dirty.”
  • Frame OUD as a chronic medical condition.
    • “Opioid use disorder is a treatable medical condition similar to diabetes or hypertension in that it often requires ongoing treatment.”
  • Emphasize patient autonomy.
    • “My role is to provide information and support your goals. We’ll decide together what approach fits you best.”
  • Use motivational interviewing techniques.
    • Ask open-ended questions.
    • Reflect ambivalence.
    • Explore the patient’s goals before discussing medications.
  • Normalize medication treatment.
    • “Medication is one of several evidence-based tools that can help people recover and stay alive.”

Can an RN provide MAT/MOUD care, and what parts of care are within RN scope?

Yes. Registered nurses play a critical role in MOUD care.

  • Depending on state nurse practice acts and organizational policies, RNs commonly:
    • Provide initial screening across primary care and other healthcare specialties and settings to increase early intervention
    • Screen for substance use and withdrawal symptoms
    • Perform nursing assessments
    • Use validated tools (e.g., COWS, CIWA)
    • Provide patient and family education
    • Monitor medication adherence and response
    • Assess side effects and safety concerns
    • Coordinate care among providers
    • Promote harm reduction (naloxone education and safer-use counseling)
    • Support motivational interviewing and recovery planning
    • Identify relapse risk and escalate concerns appropriately
    • Connect patients with community resources and recovery support
  • Generally, the following are outside of independent RNs’ scope:
    • Diagnosing opioid use disorder
    • Prescribing MOUD
    • Independently initiating buprenorphine or methadone
    • Making medication changes without appropriate provider authorization

How can I explain to families that medication treatment is evidence-based care, not “replacing one drug with another”?

Helpful Talking Points

  • Start with empathy
    • “Many families have heard that concern, so it’s a very common question.”
  • Then explain:
    • Addiction changes how the brain functions.
    • Medications such as buprenorphine and methadone stabilize brain changes.
    • When taken as prescribed, these medications:
      • Reduce cravings
      • Prevent withdrawal
      • Decrease illicit opioid use
      • Lower overdose risk
      • Improve employment and family functioning
      • Increase retention in treatment
  • Clarify an important distinction
    • “Addiction isn’t simply taking a medication; it’s the compulsive use of a substance despite harm and loss of control. Medications used for opioid use disorder are prescribed, carefully monitored, and intended to restore health and function.”
  • Address common misconceptions
    • Families often worry that medications prevent “real recovery.”
    • You might respond:
      • “For many people, medication makes recovery possible by allowing the brain to heal so they can fully participate in counseling, work, parenting, and rebuilding relationships.”

What are some considerations for treating specific populations for OUD?

  • APNA offers free grant-funded education to help you with these topics:
    • Emerging Threats in OUD
    • Prescription Stimulant Misuse in Adolescents
    • Pregnant and Postpartum Patients with Opioid Use Disorder
    • Psychiatric Nursing and Rural Opioid Safety Strategies
    • Building Capacity for Addiction Care in Rural Areas
    • Threading Addiction Care Through Nursing Education

Trusted Organizations

Opioid Response Network – Lessons Learned, Promising Models, Education
A coalition of the American Academy of Addiction Psychiatry (AAAP) and 27 national professional organizations, including APNA. This two-year SAMHSA grant helps to provide technical assistance (TA) to states and territories to enhance efforts already underway throughout the United States and territories. ORN provides training and technical assistance via local experts across the country, focusing on applying evidence-based practices in prevention, treatment and recovery to meet locally identified needs.

Providers Clinical Support System – Education, Mentoring, Clinical Resources
A national training and clinical mentoring project developed in response to the opioid use disorder crisis. With resources and training developed for primary care providers, the overarching goal of PCSS is to provide the most effective evidenced-based clinical practices in the prevention of OUD through proper opioid prescribing practices, identifying patients with OUD, and the treatment of opioid use disorder.

Current Regulatory Status for Prescribing Medication for Opioid Use Disorder

As of June 2023: The current DEA practice guidelines require Advanced Practice Registered Nurses (APRN) who have or are applying for Schedule III authority to complete an 8-hour MSUD: Medications for Substance and Opioid Use Disorder course (8 hours of education on the treatment of persons with a substance use disorder diagnosis).

The Consolidated Appropriations Act of 2023 enacted a new one-time, eight-hour training requirement for all DEA-registered practitioners, except veterinarians, on the treatment and management of patients with opioid or other substance use disorders. Learn More

(January 2023) DEA X-Waiver Requirement Eliminated
The Drug Enforcement Agency (DEA) has announced that there is no longer a requirement for an X-Waiver (or DATA 2000 Waiver) to prescribe buprenorphine for the treatment of opioid use disorders (OUD), if the practitioner:

  • Holds an active DEA license to prescribe controlled substances
  • Is allowed to prescribe under their state nursing practice act and regulation

All practitioners who have a current DEA registration that includes Schedule III authority, may now prescribe buprenorphine for OUD if permitted by applicable state law. Limits to the number of patients for which a practitioner can prescribe buprenorphine for OUD have also been removed.

The DEA and SAMHSA are developing further guidance and new training requirements will be issued in June. APNA is monitoring this issue and will continue to keep you updated of any developments.

(2021) In accordance with 2021 changes in practice guidelines for administering buprenorphine for the treatment of opioid use disorder, Advanced Practice Registered Nurses (APRN) are required to apply to the Drug Enforcement Agency for a waiver to prescribe buprenorphine. To treat more than 30 patients, providers must complete 24 hours of specialized training to prescribe buprenorphine, one of three medications approved by the FDA for the treatment of opioid use disorder.

(November 2019) Update from Medicaid and CHIP Payment and Access Commission (MACPAC) meeting:

At its October 31, 2019, meeting, the Medicaid and CHIP Payment and Access Commission (MACPAC) presented its findings on the impact of authorizing NPs and PAs to obtain a waiver to prescribe medication-assisted treatment (MAT) in the Comprehensive Addiction and Recovery Act (CARA). The presentation highlighted that this authorization in CARA increased access to treatment for patients in need of MAT. This increase in access was most pronounced in the Medicaid population, and nurse practitioners (NPs) and physician assistants (PAs) made up a higher proportion of rural waived providers. The presentation also noted that the increase in access was greatest in full practice authority states. This data shows that authorizing NPs to prescribe MATs is crucial to combat the opioid epidemic, but state barriers to practice lead to inequality in access to this important treatment. Access the slides presented by MACPAC.

(August 2017) Clarification received from SAMHSA:

Nurse practitioners and physician assistants may use their waiver to prescribe buprenorphine products for the treatment of opioid use disorder in any healthcare setting including OTPs. However, the healthcare setting or employer, OTP or otherwise, is free to establish by policy which services are to be provided and by which professionals. Any practitioner who uses the waiver to treat patients must comply with their patient limit regardless of the treatment setting. Nurse practitioners and physician assistants may order buprenorphine or methadone for administration or dispensing from an OTP without a DATA waiver, but must receive an exemption from SAMHSA to make dose and administration adjustments.

(May 2017) Updates to the three aspects of the MAT waiver process for APRNs: the required 24 hours of education, the process for issuing MAT waivers, and the regulations for implementing the CARA 2016 legislation.

  • Educational Content for Required Training
    PCSS-MAT waiver training coursework has been released. Access the course here free of charge.
  • OMB Approval of MAT Waiver Issuance Process
    From SAMHSA Website as of February 28, 2017:

NPs and PAs who have completed the 24 hours of required training may seek to obtain a DATA 2000 waiver for up to 30 patients by completing the Waiver Notification Form. Effective February 27, 2017, SAMHSA will only accept electronic submissions of the NOI. NPs and PAs may send copies of their training certificates to infobuprenorphine@samhsa.hhs.gov or faxed them to 301-576-5237.

These waiver applications will be forwarded to the DEA, which will assign the NP or PA a special identification number. DEA regulations require this number to be included on all buprenorphine prescriptions for opioid dependency treatment, along with the NP’s or PA’s regular DEA registration number. SAMHSA shall review waiver applications within 45 days of receipt. If approved, NPs and PAs will receive a letter via email that confirms their waiver and includes their prescribing identification number.

  • HHS Regulation to Implement CARA 2016
    No further HHS regulation is needed before eligible NPs or PAs with a properly authorized wavier can begin prescribing buprenorphine, subject to applicable statutory patient limits.

 

Updated August 2026

Your dynamic community of Psychiatric-Mental Health Nurses.

Connect with fellow psychiatric-mental health nurses, be the first to know about evidence-based resources and programs, and participate in exclusive opportunities to advance the care and treatment of those with mental health & substance use needs.

JOIN TODAY MEMBER COMMUNITY

Footer Cta