TITLE 18. PROFESSIONAL AND OCCUPATIONAL LICENSING
TITLE 18. PROFESSIONAL AND OCCUPATIONAL LICENSING
BOARD OF MEDICINE
Final Regulation
REGISTRAR'S NOTICE: The Board of Medicine is claiming an exemption from Article 2 of the Administrative Process Act in accordance with § 2.2-4006 A 4 a of the Code of Virginia, which excludes regulations that are necessary to conform to changes in Virginia statutory law or the appropriation act where no agency discretion is involved. The board will receive, consider, and respond to petitions by any interested person at any time with respect to reconsideration or revision.
Title of Regulation: 18VAC85-21. Regulations Governing Prescribing of Opioids and Buprenorphine (amending 18VAC85-21-130).
Statutory Authority: §§ 54.1-2400 and 54.1-2928.2 of the Code of Virginia.
Effective Date: September 23, 2026.
Agency Contact: Erin Barrett, Director of Legislative and Regulatory Affairs, Department of Health Professions, Perimeter Center, 9960 Mayland Drive, Suite 300, Henrico, VA 23233, telephone (804) 750-3912, fax (804) 915-0382, or email erin.barrett@dhp.virginia.gov.
Summary:
Pursuant to Chapters 207 and 208 of the 2026 Acts of Assembly, the amendments (i) allow practitioners prescribing buprenorphine for opioid use disorder to offer appropriate counseling to a patient in addition to referring the patient to counseling, (ii) require that such counseling or referral to counseling be documented in the patient's medical record, and (iii) stipulate that a patient's refusal of such counseling or referral to counseling does not preclude the patient from receiving office-based buprenorphine treatment for opioid use disorder.
18VAC85-21-130. General provisions pertaining to prescribing of buprenorphine for opioid use disorder.
A. Practitioners shall abide by all federal and state laws and regulations governing the prescribing of buprenorphine for the treatment of opioid use disorder.
B. Physician assistants shall prescribe buprenorphine for opioid use disorder pursuant to a practice agreement with a patient care team doctor of medicine or doctor of osteopathic medicine.
C. Practitioners engaged in medication-assisted treatment shall either provide offer counseling in their practice or refer the patient to a mental health service provider, as defined in § 54.1-2400.1 of the Code of Virginia, who has the education and experience to provide substance misuse counseling or provide a referral for counseling to each patient as clinically indicated. The practitioner shall document the provision of counseling or a referral for counseling in the medical record. A patient's refusal to receive counseling does not preclude the patient from receiving office-based buprenorphine treatment for opioid use disorder.
VA.R. Doc. No. R27-8656; Filed July 29, 2026