May 21, 2024
Buprenorphine Prescribing

Elimination of X Waiver for Buprenorphine Prescribing: A Step Forward, But Not Enough to Boost Utilization, According to New Study

A recent policy change in the United States that eliminated the need for a federal waiver for prescribing buprenorphine, a medication used to treat opioid addiction and prevent fatal overdoses, has led to an increase in the number of prescribers. However, the number of patients receiving this lifesaving drug has remained relatively unchanged, according to a new study published in the New England Journal of Medicine.

For years, doctors and other healthcare professionals in the U.S. required a special permission, known as an X waiver, to prescribe buprenorphine. This requirement was removed on January 12, 2023, due to an item in a major federal budget bill. As a result, any clinician with a license to prescribe controlled substances could now prescribe buprenorphine.

University of Michigan researchers conducted a study to examine the impact of this policy change on the number of buprenorphine prescribers and patients in the year following the elimination of the X waiver. The study found that the number of prescribers increased rapidly, with more than 53,600 clinicians prescribing buprenorphine by December 2023, up from 42,100 in December 2022.

Despite the increase in available treatment providers, the number of patients receiving buprenorphine remained stagnant. In any given month of 2022, approximately 810,000 to 830,000 Americans were prescribed buprenorphine, and these numbers changed little after January 2023.

“Our findings suggest that elimination of the federal waiver requirement reduced barriers to buprenorphine prescribing but unfortunately was insufficient to increase overall use,” said Kao-Ping Chua, M.D., Ph.D., the study’s first author.

The study also found a small increase in the number of new patients starting buprenorphine treatment in January 2023, with more than 48,200 patients starting the medication in December 2023, up from 46,500 in December 2022. However, people with opioid addiction often need to take buprenorphine daily for months to years to overcome addiction, making it essential to address the underlying barriers to accessing this medication.

The researchers believe that the stigma surrounding opioid addiction treatment and the challenges of adding new types of care and support in overburdened primary care and pain clinics may be contributing to the low number of patients receiving buprenorphine treatment.

The study’s senior author, Thuy Nguyen, Ph.D., emphasized the importance of addressing these barriers to increase the utilization of buprenorphine treatment. “The government’s decision to eliminate the waiver was designed to decrease barriers to buprenorphine prescribing and promote access to this lifesaving drug. However, our findings highlight the need to address the many other barriers to buprenorphine prescribing that must be overcome.”

The researchers have previously shown that even with earlier policy changes, such as telehealth-based prescribing and allowing prescribers to obtain an X waiver to prescribe buprenorphine to fewer patients without undergoing extensive training, the number of new patients using buprenorphine for the first time remained flat between 2019 and 2022.

The study’s authors include Kao-Ping Chua, M.D., Ph.D., Amy Bohnert, Ph.D., Mark Bicket, M.D., Ph.D., Pooja Lagisetty, Ph.D., Rena Conti, Ph.D., and Thuy Nguyen, Ph.D., all of whom have been involved in the Michigan Opioid Collaborative (MOC) effort to increase the availability of buprenorphine to patients in Michigan. The MOC team has helped primary care providers, hospitals, and others increase the availability of buprenorphine to patients through free consultations, training events, and more.

The MOC team’s findings from the effort’s first years were published in JAMA Network Open. The study showed a clear, sharp rise in both prescribers offering the treatment and people receiving it in counties where MOC had a presence, compared with those where it wasn’t yet available. MOC now covers all areas of the state, though the study covers a time period through 2020 when there were still more than 20 counties not yet participating.

1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile it.