Buprenorphine—used to treat opioid use disorder—is the only drug that ever came with federal limits on the number of patients a provider could care for. It also came with restrictions on the types of clinicians who could prescribe it. Rules requiring the so-called “x-waiver” for prescribing clinicians were ultimately repealed in December 2022. Since then, providers have been able to offer buprenorphine to any number of patients who need addiction treatment and a path to recovery. However, even with the x-waiver mandate eliminated, the number of providers prescribing buprenorphine has not grown as expected. An analysis of emergency department data in Stat News reveals visits among patients with opioid use disorder that resulted in a buprenorphine prescription increased only slightly: from 2% in 2019 to 8% in 2023. The drug treatment is strongly recommended and has demonstrated excellent efficacy. Many observers believed the cumbersome x-waiver training, tracking, and paperwork requirements were the big turnoff for providers. With the x-waiver removed, buprenorphine prescriptions should have taken off—in theory. An estimated 27.2 million people have a drug-use disorder, according to federal data released in November 2023, so a lot of patients could stand to benefit from treatment.
Buprenorphine as a risk reduction strategy: “There has not been a material increase in buprenorphine prescribing because providers are concerned about diversion—ie, patients could sell or give away some of their meds,” says Alan Ayers, MBA, MAcc, president of Experity Consulting and Senior Editor of JUCM. “Studies, however, indicate that diversion is still a risk-reduction strategy versus the risk of overdose from heroin or fentanyl.” Learn more about the effect of repealing the x-waiver from the JUCM archive: The X-Waiver Is No More: What This Means For Urgent Care