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Buprenorphine Regs Loosen, But Some Barriers Remain

Since Congress last December approved a change in federal drug policy that scrapped a special licensing requirement, the so-called X waiver, the pool of physicians and health workers who can prescribe the opioid-addiction medication buprenorphine expanded dramatically. Hundreds of thousands of providers have become newly eligible to treat opioid users with it, a move President Biden celebrated in his State of the Union address last month. But addiction experts warn that lifting the buprenorphine restrictions may not prove to be the best solution due to lingering problems with training and accessibility, the New York Times reports. Medical schools tend not to incorporate opioid addiction in their curriculums, leaving younger doctors without specific training in treating drug users. Some health providers with busy medical practices are wary of the psychiatric and social needs of opioid users. And even when someone obtains a prescription for buprenorphine, some pharmacies may not dispense it. “For improving access, it may be that removing the X waiver helps, but it may not be sufficient,” said Dr. David Fiellin, an addiction physician at the Yale School of Medicine who has trained other doctors pursuing X waivers. The risk, he added, was “access without quality.”


Dr. Rahul Gupta, the director of the White House’s Office of National Drug Control Policy, said in an interview that about 130,000 health providers had an X waiver at the end of last year when the rule was abolished. Now, he said, 2 million prescribers registered with the Drug Enforcement Administration can give buprenorphine to opioid users. Some treatment programs and conservative lawmakers have been reluctant to promote buprenorphine, seeing it as swapping one opioid for another, despite solid evidence of its effectiveness in treating opioid users. Some lawmakers have suggested that the removal of the X waiver requirement could lead to poorly trained physicians making uninformed prescribing decisions, or the misuse or sale of the medication. Recently, patients have also faced changing rules about how they can get medication. The federal government has allowed buprenorphine to be prescribed initially in video or phone appointments. But last week, the DEA proposed that after the pandemic public health emergency is lifted in May, doctors would be limited to prescribing a 30-day supply of buprenorphine to patients who have not had an in-person appointment, a change that could restrict access to the medication. Addiction experts say that the elimination of the waiver requirement may end up redirecting patients from specialized settings to primary care, which has lacked buprenorphine-prescribing physicians. Some doctors are still hesitant to open their practices to opioid treatment, viewing it as a complicated undertaking that could diminish attention to other patients.

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