The MATE Act changed a small but consequential piece of the prescribing landscape for controlled substances. For physicians who prescribe buprenorphine — particularly those doing so through telehealth — understanding what the law does, and does not, require is worth a few minutes of attention.
What the MATE Act actually requires
The Medication Access and Training Expansion Act, commonly known as the MATE Act, introduced a one-time training requirement tied to DEA registration. Practitioners registering or renewing their DEA registration are generally expected to complete a set amount of training on the treatment and management of patients with opioid or substance use disorders. This training requirement applies broadly across DEA registrants rather than being limited to a narrow subset of prescribers, though various professional experiences and prior education can often satisfy it.
Buprenorphine prescribing after the X-waiver era
Buprenorphine prescribing rules have shifted substantially in recent years. The prior requirement for a separate DEA waiver to prescribe buprenorphine for opioid use disorder — often referred to as the X-waiver — was eliminated, folding buprenorphine prescribing authority into a standard DEA registration for many practitioners. The MATE Act training requirement arrived alongside this change, effectively replacing a waiver-specific hurdle with a broader educational expectation.
The MATE Act traded a narrow waiver requirement for a broader training expectation that applies across DEA registrants.
How this intersects with telehealth
Buprenorphine prescribed via telehealth sits at the intersection of controlled substance rules and telehealth-specific flexibilities that have evolved since the pandemic. Telehealth prescribing of controlled substances, including buprenorphine, has generally been supported through temporary flexibilities that allow prescribing without a prior in-person exam in many circumstances, though the scope and duration of these flexibilities has been subject to periodic extension. Physicians prescribing buprenorphine via telehealth typically need to track both their MATE Act training compliance and the current state of telehealth-specific controlled substance flexibilities, since the two operate on separate tracks.
State-level considerations
Even where federal telehealth flexibilities permit buprenorphine prescribing without an in-person visit, state medical boards and state controlled substance authorities may layer on their own expectations regarding telehealth modality, informed consent, or follow-up care. A prescriber licensed in multiple states may find that buprenorphine telehealth practices considered routine in one state carry additional documentation expectations in another.
Because both the training requirement and telehealth prescribing flexibilities have changed multiple times in recent years, it is worth periodically reconfirming current status. Requirements vary by state and change over time — always confirm current requirements directly with the relevant state board or agency before making a compliance decision.