Introduction
The majority of states now require physicians to complete continuing medical education on controlled substance prescribing, opioid management, and addiction recognition. Combined with the federal DEA MATE Act requirement, understanding these obligations is essential for license renewal and DEA registration.
This guide provides complete state-by-state requirements for 2026, including hours required, topics covered, and where to find approved courses.
Federal DEA MATE Act Requirement
Overview
The Medication Access and Training Expansion (MATE) Act, effective June 27, 2023, requires:
| Requirement | Details |
|---|---|
| Who | All DEA registrants (new or renewing) |
| Hours | 8 hours total (one-time) |
| Topics | Opioid or substance use disorder treatment/management |
| Deadline | Before new registration or renewal |
| Frequency | One-time requirement |
MATE Act Topics
Training must cover one or more of: - Treatment and management of patients with opioid use disorder - Treatment and management of patients with other substance use disorders - Safe prescribing of controlled substances - Identification of substance use disorders
Exemptions from MATE Act
| Exemption | Details |
|---|---|
| Board-certified addiction specialists | ABAM, ABPM addiction medicine, ABPN addiction psychiatry |
| Practitioners who don't prescribe controlled substances | Non-prescribers |
| Practitioners who only prescribe for animals | Veterinarians |
| Previous waiver holders | X-waiver practitioners (grandfathered) |
| Graduated from qualifying program | After June 27, 2023 with curriculum |
State-by-State Controlled Substance CME Requirements
States with Mandatory Opioid/Pain Management CME
| State | Hours Required | Per Cycle | Topics | Notes |
|---|---|---|---|---|
| Alaska | 2 hours | Biennial | Pain management, opioid use/addiction | Part of total CME |
| Arkansas | 1 hour | Annual | Opioids and/or benzodiazepines | For prescribers |
| California | 12 hours | One-time | Pain management, end-of-life care | By 2nd renewal |
| Connecticut | 1 hour | Annual | Controlled substances, pain management | For prescribers |
| Delaware | 2 hours | Biennial | Controlled substance prescribing | Plus 1 hour DE law |
| Florida | 2 hours | Biennial | Controlled substance prescribing | DEA registrants |
| Georgia | 3 hours | Biennial | Responsible opioid prescribing | DEA registrants |
| Illinois | 3 hours | Per cycle | Opioid prescribing | Required for IL CSR |
| Indiana | 2 hours | Biennial | Opioid prescribing, opioid abuse | Since July 2019 |
| Iowa | Varies | Biennial | CDC opioid prescribing guidelines | Primary care |
| Kentucky | 4.5 hours | Triennial | KASPER, pain management, addiction | DEA registrants |
| Louisiana | 3 hours | Annual | Drug diversion, controlled substances, addiction | For prescribers |
| Maine | 3 hours | Biennial | Opioid medication prescribing | For prescribers |
| Maryland | 2 hours | Per cycle | Prescribing/dispensing controlled substances | CDS registrants |
| Massachusetts | 3 hours | Biennial | Pain management | Required topic |
| Michigan | 3 hours | Triennial | Pain and symptom management | Required topic |
| Nebraska | 3 hours | Biennial | Opioid prescribing (incl. 0.5 hr PDMP) | Part of 50 hours |
| New Jersey | 1 hour | Biennial | Prescription opioid drugs | For prescribers |
| New York | 2 hours | Triennial | Controlled substance misuse/abuse | CDS registrants |
| North Carolina | 3 hours | Biennial | Safe opioid prescribing | For DEA registrants |
| Ohio | 2 hours | Biennial | Prescribing controlled substances | Required topic |
| Oregon | 1 hour | Biennial | Pain management | Part of CME |
| Pennsylvania | 2-4 hours | Biennial | Pain management, opioid prescribing, addiction | See details below |
| Rhode Island | 2 hours | Biennial | Opioid prescribing | For prescribers |
| Tennessee | 2 hours | Biennial | Controlled substance prescribing | DEA registrants |
| Texas | 2 hours | Biennial | Opioid-related content | DEA registrants |
| Utah | 3.5 hours | Biennial | Controlled substance prescribing | Licensed prescribers |
| Vermont | 2 hours | Biennial | Pain management/opioids | For prescribers |
| Virginia | 2 hours | Biennial | Prescribing practices | For DEA registrants |
| Washington | 4 hours | One-time | Opioid prescribing | By 2nd renewal |
| West Virginia | 3 + 3 hours | Biennial | Prescriber course + pain management | Two separate requirements |
| Wisconsin | 2 hours | Biennial | Opioid prescribing | For prescribers |
Pennsylvania Detail
| Physician Type | Requirement |
|---|---|
| First-time licensees | 2 hours pain management/addiction + 2 hours safe opioid prescribing |
| Renewing prescribers | 2 hours pain management, addiction identification, OR safe opioid prescribing |
States WITHOUT Mandatory Opioid CME
These states don't have state-specific controlled substance CME mandates (though federal MATE Act still applies):
| State | Notes |
|---|---|
| Alabama | No state opioid CME mandate |
| Arizona | No state opioid CME mandate |
| Colorado | No state opioid CME mandate (CME requirement starts Jan 2026) |
| Hawaii | No state opioid CME mandate |
| Idaho | No state opioid CME mandate |
| Kansas | No state opioid CME mandate |
| Minnesota | No state opioid CME mandate |
| Mississippi | No state opioid CME mandate |
| Missouri | No state opioid CME mandate |
| Montana | No state CME requirement at all |
| Nevada | No state opioid CME mandate |
| New Hampshire | No state opioid CME mandate |
| New Mexico | No state opioid CME mandate |
| North Dakota | No state opioid CME mandate |
| Oklahoma | No state opioid CME mandate |
| South Carolina | No state opioid CME mandate |
| South Dakota | No state CME requirement at all |
| Wyoming | No state opioid CME mandate |
Topics Typically Covered
Core Content Areas
| Topic | Description |
|---|---|
| Safe prescribing practices | Evidence-based opioid prescribing guidelines |
| Risk assessment | Screening tools, patient evaluation |
| PDMP usage | How to effectively use monitoring programs |
| Addiction recognition | Signs and symptoms of substance use disorder |
| Alternative treatments | Non-opioid pain management options |
| Tapering protocols | Safe dose reduction strategies |
| Naloxone co-prescribing | When and how to prescribe reversal agents |
| State regulations | State-specific prescribing rules |
| DEA requirements | Federal controlled substance regulations |
| Documentation | Proper medical record documentation |
CDC Opioid Prescribing Guidelines
Many states require training on CDC guidelines, which include: - Nonpharmacologic and nonopioid therapy preferred - Lowest effective dose when opioids needed - Immediate-release opioids preferred for acute pain - 3-7 days typically sufficient for acute pain - Regular reassessment for chronic pain - Avoid concurrent benzodiazepines
Where to Find Approved Courses
Free CME Resources
| Provider | Course Availability | Credits |
|---|---|---|
| CDC TRAIN | Opioid prescribing guidelines | Free AMA PRA Cat 1 |
| SAMHSA | Substance use disorder treatment | Free, various credits |
| Medscape | Multiple opioid/pain courses | Free AMA PRA Cat 1 |
| Pri-Med | DEA MATE Act courses | Free AMA PRA Cat 1 |
| AMA Ed Hub | Substance use disorder education | Free for AMA members |
State Medical Society Courses
Most state medical societies offer approved controlled substance CME:
| Society | Notes |
|---|---|
| California Medical Association | CA-specific requirements |
| Texas Medical Association | Pain management courses |
| Florida Medical Association | Controlled substance courses |
| Pennsylvania Medical Society | Opioid CME for PA physicians |
Specialty Society Courses
| Specialty | Resources |
|---|---|
| Family Medicine (AAFP) | Pain management CME |
| Internal Medicine (ACP) | Opioid prescribing courses |
| Emergency Medicine (ACEP) | Acute pain management |
| Anesthesiology (ASA) | Chronic pain courses |
Compliance Strategies
For Multi-State Licensees
If licensed in multiple states with different requirements:
- Identify strictest requirement - Take course meeting highest hour count
- Verify acceptance - Ensure course meets each state's specific topics
- Document separately - Some states want separate certificates
- Time courses strategically - Complete early in renewal cycle
- Track by state - Different deadlines may apply
Meeting Both State and DEA Requirements
| Strategy | How It Works |
|---|---|
| One comprehensive course | Take 8-hour course covering all topics |
| Combined approach | Stack state-required + additional for MATE |
| Specialty-focused | Take courses relevant to your practice |
Documentation Best Practices
| Practice | Purpose |
|---|---|
| Keep all certificates | Proof of completion |
| Note specific topics covered | Shows compliance with mandated content |
| Track hours by category | Separate opioid hours from general CME |
| Record completion dates | Verify within renewal period |
Key Takeaways
- Federal MATE Act requires 8 hours one-time for all DEA registrants
- Most states require 1-3 hours per cycle of opioid/pain CME
- Requirements vary significantly - check your specific state(s)
- Free courses available through CDC, SAMHSA, Medscape
- Multi-state physicians should identify and meet strictest requirements
- Document carefully - separate opioid CME from general CME records
Frequently Asked Questions
Do I need to complete both state CME AND federal MATE Act training?
Yes, these are separate requirements. The state CME is typically required every renewal cycle, while the MATE Act is a one-time federal requirement. Some courses can count toward both, but you need to meet each requirement independently. If your state requires 2 hours biennially and you've completed the 8-hour MATE requirement, you still need the state hours for renewal.
What if I don't prescribe opioids—do I still need this CME?
It depends on your state and DEA registration status. Many states only require opioid CME for DEA-registered prescribers or those who actually prescribe controlled substances. If you have no DEA registration and don't prescribe controlled substances, you may be exempt from state requirements. However, if you have a DEA registration, you must meet MATE Act requirements to renew it, even if you rarely prescribe.
Can online courses satisfy these requirements?
Yes, most states accept online AMA PRA Category 1 CME for controlled substance requirements. However, some states require specific state-approved courses, so verify that your online course is accepted before completing it. Look for courses specifically stating they meet MATE Act and/or your state's opioid CME requirements.
Are there exemptions for certain specialties?
Some states exempt specialties that don't typically prescribe controlled substances (pathology, radiology without procedures). Board-certified addiction specialists may be exempt from MATE Act requirements. Check your specific state's rules—exemptions vary significantly. Even if exempt from state requirements, you may still need MATE training for DEA registration.
How do I document completion for multiple states?
Complete courses that meet the strictest requirements among your licensed states. Keep certificates from each course, and when renewing in each state, identify which specific CME meets that state's requirement. Some states have online systems where you report CME; others require attestation at renewal. Track hours by topic (opioid/pain) separately from general CME.
Conclusion
Controlled substance CME requirements have become standard across most states, reflecting ongoing efforts to address the opioid crisis. Combined with federal MATE Act requirements, physicians must navigate multiple compliance obligations. Planning your CME strategically—completing comprehensive courses early in your renewal cycle—ensures you meet all requirements efficiently.
Use CredentialMate to track controlled substance CME requirements across all your licensed states, receive reminders when training is due, and document compliance for each jurisdiction.
References
[1]: FSMB - Continuing Medical Education by State https://www.fsmb.org/siteassets/advocacy/key-issues/continuing-medical-education-by-state.pdf Last updated: October 2025
[2]: BoardVitals - Pain Management & Opioid CME Requirements by State https://www.boardvitals.com/blog/pain-management-opioid-cme-requirements-by-state/ Last verified: January 2026
[3]: Pri-Med - State CME Requirements https://www.pri-med.com/state/state-mandated Last verified: January 2026
[4]: Pri-Med - Free DEA CME Requirements Training https://www.pri-med.com/state/dea-cme-requirements Last verified: January 2026
[5]: AMA Ed Hub - Substance Use Disorders Education https://edhub.ama-assn.org/course/302 Last verified: January 2026
[6]: North Carolina Medical Board - Controlled Substances CME https://www.ncmedboard.org/landing-page/controlled-substances-cme-requirement Last verified: January 2026
[7]: Pennsylvania Medical Society - Opioid CME https://www.pamedsoc.org/opioids-cme Last verified: January 2026
[8]: SAMHSA - Training and Education https://www.samhsa.gov/ Last verified: January 2026