Public Policy

Breaking News: X-waiver Eliminated

On January 12, 2023, the U.S. Drug Enforcement Administration (DEA) and the Substance Abuse
and Mental Health Services Administration (SAMHSA) announced the immediate elimination of the X-waiver for prescribing buprenorphine, as required by the omnibus bill passed in December  2022. SHM celebrates this change as a major victory for our collective advocacy efforts and for improving the care of patients with opioid use disorder (OUD).

The removal of the X-waiver requirement has been one of SHM’s top policy priorities since 2018, as we viewed the X-waiver as an inappropriate and outdated barrier to treating OUD. Over the past five years, SHM’s Public Policy Committee educated congressional leaders on Capitol Hill about the safety and efficacy of buprenorphine, addressed their misconceptions and concerns about abuse and diversion, and encouraged them to support the passage of the Mainstreaming Addiction Treatment (MAT) Act to eliminate the X-waiver.

Hospitalists around the country joined us in that effort, sending messages to Congress through SHM’s Legislative Action Center. Together, we helped ensure the MAT Act’s inclusion in last year’s omnibus bill, leading to the DEA/ SAMHSA announcement. Thank you for helping secure the passage of this lifesaving legislation.

What does this mean for hospitalists?

All clinicians with a current DEA registration that includes Schedule III authority (the ability to prescribe narcotics) can prescribe buprenorphine to treat OUD. The X-waiver is no longer required to prescribe buprenorphine for OUD treatment. Additionally, there are no caps or limitations on the number of patients a prescriber can treat at one time. This fundamentally shifts care strategies for patients with OUD. Over time, we hope the elimination of the X-waiver reduces stigma and creates an expectation that medication-assisted treatment with buprenorphine is normal care that can be delivered throughout the health care system.

SHM Public Policy Committee member Dr. Suparna Dutta said “As hospitalists, we see the impact
OUD has on our communities daily. The elimination of the X-waiver is a huge step forward in improving the equity and access to care that we can provide for this population. The X-waiver was never created because of the dangers of buprenorphine nor the complexity of administering this medication. Rather, this policy reflected stigma around the diagnosis of opioid use disorder and was not congruent with the tenets of modern addiction treatment. We are so grateful to have been able to contribute to this important policy achievement on behalf of our patients and SHM and look forward to continuing to advocate for this population and the work that remains to be done.”

As the opioid epidemic continues to impact communities throughout the U.S., SHM remains committed to advocating for policies to help patients and providing education and resources to hospitalists as they implement this historic change to addiction treatment and bring this therapy into mainstream use.

Look for the full report on this issue, including how this will affect hospitalists, in the next issue of The Hospitalist.

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