SUD Stakeholders, Lawmakers Continue to Push for Widespread Buprenorphine Reforms

Substance use disorder (SUD) treatment providers have already been on a regulatory rollercoaster this year — and there could be even more changes ahead.

As one of the Trump administration’s final moves in office in January, the U.S. Department of Health and Human Services (HHS) announced that it was nixing the X-waiver requirement for DEA registered physicians, giving the majority of doctors the power to automatically prescribe buprenorphine for medication-assisted treatment (MAT) without having to go through special training.

The goal was to increase the number of clinicians prescribing the drug in an attempt to give more people access to MAT, which is the gold standard of treatment for OUD care but is not always easy for patients to access.

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But then, just a few weeks later, the Biden administration reversed those prescribing flexibilities, saying that only Congress has the power to eliminate the X-waiver. 

The back-and-forth has left many providers frustrated and split on the issue; but, at the same time, it has shone a national spotlight on the need for buprenorphine reform. 

Now, stakeholders and lawmakers alike seem to be troubleshooting how to reduce opioid use disorder (OUD) and safely improve access to MAT. 

For example, a coalition of SUD treatment groups recently wrote to HHS and the Office of National Drug Control Policy (ONDCP) to push for increased opioid training for all health care workers. They said lack of opioid education for clinicians is a bigger problem than the X-waiver, which requires doctors to complete 8 hours of training and obtain a waiver to be allowed to prescribe buprenorphine for OUD.

“We have learned that the waiver training requirement in most cases has not been a primary barrier for practitioners treating opioid use disorder,” the authors of the letter wrote. “In fact, … there is a strong desire by practitioners for additional training rather than an elimination of training.”

The letter was written on behalf of more than 150,000 addiction psychiatrists and osteopathic physicians nationwide from groups such as the American Academy of Addiction Psychiatry (AAAP), the American Osteopathic Academy of Addiction Medicine (AOAAM) and several others.

The coalition urged the Biden administration to develop new policies and programs to improve and expand buprenorphine education to better prepare health care workers to deal with patients with OUD.

Specifically, they called out the need for more training at accredited medical schools and residency programs, as well as for physician assistants and advanced practice registered nurses “to fulfill the training requirement through a comprehensive curriculum.”

Lawmakers are thinking about how to improve MAT, too.

In late February, a bipartisan group of legislators in both houses of Congress revived the Mainstreaming Addiction Treatment Act, which would eliminate unique training requirements such as the X-waiver while also requiring HHS to conduct a national educational campaign to encourage providers to integrate SUD treatment into their practices.

Plus, lawmakers are also considering the Medication Access and Training Expansion Act and Opioid Workforce Act, which also expand training requirements and opportunities for health care providers as it relates to OUD.

Still, despite all the positive momentum, only time will tell if it translates into lasting change for the SUD industry.