The three-day rule for treating acute withdrawal symptoms

Generally, federal law requires practitioners to obtain a Drug Enforcement Agency (DEA) registration or a waiver from the DEA registration to use narcotics to treat opioid addiction. However, under an exception to the DEA registration requirements, known as the “three-day rule,” practitioners who are not otherwise registered with the DEA or have not obtained a waiver can administer, but not prescribe, narcotic drugs to patients for up to 72 hours. Drugs such as Subutex or Suboxone may be administered during this time period to relieve acute withdrawal symptoms while arranging for the patient’s referral for treatment at a detoxification treatment program.

The three-day rule permits practitioners to administer no more than one day’s medication at a time for a maximum of three days, which cannot be renewed or extended. During the three-day period, the provider is expected to arrange for the patient’s referral for treatment in a maintenance or detoxification program.  The goal of the three-day rule is to allow health care providers some flexibility to address emergency situations when a patient is experiencing acute withdrawal. Using the flexibility afforded by the three-day rule, some providers are offering withdrawal treatment services in an effort to address the growing demand for withdrawal treatment resulting from the opioid crisis and other substance abuse. Before initiating such treatment, however, a provider should be clear regarding the applicable rules and regulations for such treatment.