Overdose Epidemic

DEA opioid training requirements and the MATE Act explained with Sanjay Desai, MD


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The MATE Act requires DEA-registered physicians to take eight hours of training on treating and managing patients with opioid or other substance use disorders. Sanjay Desai, MD, chief academic officer and group vice president of medical education at the American Medical Association, shares what doctors need to know and how to complete DEA license renewal. AMA Chief Experience Officer Todd Unger hosts.


  • Sanjay Desai, MD, chief academic officer and group vice president of medical education, AMA

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Unger: Hello and welcome to the AMA Update video and podcast. Today, we're talking about the MATE Act and how it can be incorporated into GME training. I'm joined by Dr. Sanjay Desai, AMA's chief academic officer and group vice president of medical education in Chicago. I'm Todd Unger, AMA's chief experience officer, also in Chicago. Dr. Desai, it's a pleasure to have you back.

Dr. Desai: Thanks. It's nice to be here.

Unger: The Medical Access and Training Expansion Act, better known as the MATE Act, requires increased training for DEA-registered physicians and practitioners Dr. Desai, let's just start by talking about a little background on the requirement and what it entails for physicians.

Dr. Desai: Sure, Todd. So this MATE Act officially went into effect back in June of 2023. And essentially, it requires physicians to complete eight hours of training on treating and managing patients with opioid or other substance use disorders.

The training is a one-time requirement. So once physicians have completed, they don't have to do it again. But it is required whether you've been practicing for a long time or you're brand-new into practice.

It's also important to note that the training can be done across multiple sessions. It's eight hours, but it can be broken up. And physicians can count past trainings from certain providers towards these eight hours as well.

Unger: Dr. Desai, as I understand it, the AMA had some initial issues with the MATE Act and we expressed those concerns to Congress last year. For a little context, what was Congress thinking about this?

Dr. Desai: Yeah, so you know, as we saw in our most recent overdose epidemic report from 2022, opioid prescribing has decreased year over year for the last 10 years—almost a 50% reduction in total. However, overdoses and deaths related to illicitly manufactured fentanyl, methamphetamine and cocaine continue to unfortunately increase. And so the epidemic is very much still a pressing issue, and it's in need of even more urgent action.

And Congress was considering multiple legislative proposals to try to address this urgent need. And some of them they may have supported, such as eliminating the need for physicians to obtain an X waiver. This was a waiver that physicians had to have to prescribe medications for opioid use disorder and it was a barrier. So we were in favor of eliminating that.

The AMA was concerned, however, that there were unintended consequences for patient care related to the MATE Act's training requirement. So for example, even without the X waiver, mandating eight hours of training in substance use disorder for DEA registration, that can be a barrier for caring for patients who are being treated with controlled medications, whether or not they have a substance use disorder. In addition, we know that there's no evidence that CME mandates have led to reductions in opioid-related overdoses or deaths or improved outcomes, which is another concern for ours. But now that the MATE Act is law, the AMA is working to make fulfilling the training as easy as possible, and as meaningful as possible, for physicians around the country.

Unger: And we're going to talk about that in a little, bit how we're making that easier. First, let's talk about what the MATE Act means for residents and fellows who are registering with the DEA for the first time. Do they still need to take this training?

Dr. Desai: Yeah, actually, everybody has to take the training. So all DEA-registered physicians in the country are required to complete this training. Regardless, again, if you're a first-time, as I mentioned before, or if you're renewing as well, it still requires a testing that they've completed the eight hours of training that's required by the MATE Act or eight hours that creates eligibility for this completion.

But that being said, physicians that have already completed eight hours of training and many have before on this topic, do not need to do it again. For example, if you've graduated in good standing from a medical school within five years of the act, which is June 27, 2023, and your institution provided training on all FDA-approved medications to treat opioid and other substance use disorders, then you've already satisfied this training requirement. However, that means if you're a fellow resident that's been in training longer than that, they may still need to complete the eight hours of training.

Unger: Dr. Desai, what have you been hearing from GME institutions about the MATE Act? And how have they been helping the residents and fellows meet the requirement.

Dr. Desai: Yeah, we've actually heard a lot, Todd, from GME institutions lately about the MATE Act. Especially as it's been there, and now people are renewing, it's become a very notable topic for GME institutions. And they want to understand how they can help their trainees meet these requirements. And the AMA can absolutely help with this.

So the AMA GME Competency Education Program has everything that institutions need to help their residents and fellows comply with the MATE Act. If you're a GME institution already using this program, all you need to do is assign these seven courses to your learners, and that's it. From there, you can track their progress on the back end, and you can make sure that all the residents and fellows have completed the courses.

If you happen to be a program or an institution that's not using the program, you can learn more about it on the AMA website by visiting ama-assn.org/gcep—G- C- E- P. For GME institutions that already provide eight hours of training in substance use disorders, we encourage them to tell their residents, and provide them with the type of documentation that they would find helpful in verifying and using the attestation that they need to provide on the DEA registration. And while the DEA doesn't require physicians to submit that proof, again, we encourage this as a best practice to keep records for their files.

Unger: Absolutely. And for physicians out there, you can also find an easy-made solution for you on the AMA's Ed Hub, which brings together all of the courses that you would need to complete this requirement. Dr. Desai, the MATE Act just went into effect. But long-term, what do you think the impact is going to be on the nation's drug-related overdose epidemic?

Dr. Desai: Yeah, it's such a problem, Todd. I mean, the fact that reductions in opioid prescribing have not led to reductions in drug-related mortality shows that this is incredibly complicated, and more work is needed. And education, as always, can be a powerful tool in this battle. The AMA has strongly supported medical schools and residency programs incorporating training on the broad range of issues essential to end this epidemic. We also continue to urge physicians to enhance their education on substance use disorder care, pain management and evidence-based harm reduction initiatives.

We know, however, education alone is not enough. And that's why we're also continuing to call on Congress and insurance companies to increase access to evidence-based care. That includes prohibiting prior authorization and step therapy for medications we know that can treat opioid re-use disorder.

Unger: Dr. Desai, thank you so much for joining us today, and for all that information. That wraps up today's episode. We'll be back soon with another AMA Update. In the meantime, you can find all our videos and podcasts at ama-assn.org/podcasts. Thanks for joining us. Please take care.

Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.