Buprenorphine is one of the gold standard medication treatments for opioid use disorder (OUD), with proven effectiveness in preventing overdose, increasing abstinence, and improving quality of life. In the United States, buprenorphine can be legally prescribed and administered in office-based settings from clinicians who are specially credentialed to provide that care under the X-waiver. We believe the X-waiver will ultimately be repealed, but there is a need for a variety of strategies to create a new treatment system after the X-waiver. Building a new tier of treatment capacity will require educational outreach, systems strategies, and enhanced payments.
GiacomuzziSM, ErtlM, KemmlerG, RiemerY, ViglA.Sublingual buprenorphine and methadone maintenance treatment: a three-year follow-up of quality of life assessment. ScientificWorldJournal. 2005;5:452–468.
2.
GiacomuzziSM, RiemerY, ErtlM, . Buprenorphine versus methadone maintenance treatment in an ambulant setting: a health-related quality of life assessment. Addiction. 2003;98(5):693–702.
3.
PonizovskyAM, GrinshpoonA.Quality of life among heroin users on buprenorphine versus methadone maintenance. Am J Drug Alcohol Abuse. 2007;33(5):631–642.
4.
PonizovskyAM, MargolisA, HeledL, RoscaP, RadomislenskyI, GrinshpoonA.Improved quality of life, clinical, and psychosocial outcomes among heroin-dependent patients on ambulatory buprenorphine maintenance. Subst Use Misuse. 2010;45(1-2):288–313.
5.
MattickRP, KimberJ, BreenC, DavoliM.Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Syst Rev. 2004;2004(3):CD002207.
6.
VolkowND, CollinsFS.The role of science in addressing the opioid crisis. N Engl J Med. 2017;377(4):391–394.
7.
VolkowND, FriedenTR, HydePS, ChaSS. Medication-assisted therapies-tackling the opioid-overdose epidemic. N Engl J Med. 2014;370(22):2063–2066.
8.
ThomasCP, FullertonCA, KimM, . Medication-assisted treatment with buprenorphine: assessing the evidence. Psychiatr Serv. 2014;65(2):158–170.
9.
LevyS, SealeJP, OsborneVA, . The Surgeon General's Facing Addiction report: an historic document for health care. Subst Abus. 2017;38(2):122
10.
FrankJW, WakemanSE, GordonAJ.No end to the crisis without an end to the waiver. Subst Abus. 2018;39(3):263–265.
11.
McBainRK, DickA, SorberoM, SteinBD. Growth and distribution of buprenorphine-waivered providers in the United States, 2007-2017. Ann Intern Med. 2020;172(7):504–506.
12.
DickAW, PaculaRL, GordonAJ, . Growth in buprenorphine waivers for physicians increased potential access to opioid agonist treatment, 2002-11. Health Aff. 2015;34(6):1028–1034.
13.
JonesCM, CampopianoM, BaldwinG, McCance-KatzE.National and state treatment need and capacity for opioid agonist medication-assisted treatment. Am J Public Health. 2015;105(8):e55–e63.
14.
Substance Abuse and Mental Health Services Administration. Results from the 2019 National Survey on Drug Use and Health: detailed tables. Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/data/report/2019-nsduh-detailed-tables. Published 2019. Accessed February 12, 2021.
15.
SteinBD, PaculaRL, GordonAJ, . Where is buprenorphine dispensed to treat opioid use disorders? The role of private offices, opioid treatment programs, and substance abuse treatment facilities in urban and rural counties. Milbank Q. 2015;93(3):561–583.
16.
OlivaEM, TraftonJA, HarrisAHS, GordonAJ.Trends in opioid agonist therapy in the Veterans Health Administration: is supply keeping up with demand?Am J Drug Alcohol Abuse. 2013;39(2):103–107.
17.
JaffeJH, O'KeeffeC.From morphine clinics to buprenorphine: regulating opioid agonist treatment of addiction in the United States. Drug Alcohol Depend. 2003;70(2 Suppl):S3–S11.
18.
TierneyM, FinnellDS, NaegleMA, LaBelleC, GordonAJ.Advanced practice nurses: Increasing access to opioid treatment by expanding the pool of qualified buprenorphine prescribers. Subst Abus. 2015;36(4):389–392.
19.
GordonAJ, LibertoJ, GrandaS, Salmon-CoxS, AndreeT, McNicholasL.Outcomes of DATA 2000 certification trainings for the provision of buprenorphine treatment in the Veterans Health Administration. Am J Addict. 2008;17(6):459–462.
20.
SteinBD, SorberoM, DickAW, PaculaRL, BurnsRM, GordonAJ.Physician capacity to treat opioid use disorder with buprenorphine-assisted treatment. JAMA. 2016;316(11):1211–1212.
21.
DuncanA, AndermanJ, DeseranT, ReynoldsI, SteinBD.Monthly patient volumes of buprenorphine-waivered clinicians in the US. JAMA Netw Open. 2020;3(8):e2014045.
22.
OlivaEM, MaiselNC, GordonAJ, HarrisAHS.Barriers to use of pharmacotherapy for addiction disorders and how to overcome them. Curr Psychiatry Rep. 2011;13(5):374–381.
23.
AllenB, NolanML, PaoneD.Underutilization of medications to treat opioid use disorder: What role does stigma play?Subst Abus. 2019;40(4):459–465.
24.
CunninghamCO, KuninsHV, RooseRJ, ElamRT, SohlerNL.Barriers to obtaining waivers to prescribe buprenorphine for opioid addiction treatment among HIV physicians. J Gen Intern Med. 2007;22(9):1325–1329.
KelleyAT, DunganMT, GordonAJ.Barriers and facilitators to buprenorphine prescribing for opioid use disorder in the veterans health administration during COVID-19. J Addict Med. Published online December 14, 2020. [epub ahead of print].
27.
LiX, ShorterD, KostenTR.Buprenorphine in the treatment of opioid addiction: opportunities, challenges and strategies. Expert Opin Pharmacother. 2014;15(15):2263–2275.
28.
HaffajeeRL, BohnertASB, LagisettyPA.Policy pathways to address provider workforce barriers to buprenorphine treatment. Am J Prev Med. 2018;54(6 Suppl 3):S230–S242.
29.
SinskyCA, DugdaleDC.Medicare payment for cognitive vs procedural care: minding the gap. JAMA Intern Med. 2013;173(18):1733–1777.
30.
JamesJR, GordonLM, KleinJW, MerrillJO, TsuiJI.Interest in prescribing buprenorphine among resident and attending physicians at an urban teaching clinic. Subst Abus. 2019;40(1):11–13.
31.
ZerboE, TrabaC, MatthewP, . DATA 2000 waiver training for medical students: lessons learned from a medical school experience. Subst Abus. 2020;41(4):463–467.
32.
GordonAJ, DrexlerK, HawkinsEJ, . Stepped Care for Opioid Use Disorder Train the Trainer (SCOUTT) initiative: expanding access to medication treatment for opioid use disorder within Veterans Health Administration facilities. Subst Abus. 2020;41(3):275–282.
33.
ChangET, ObermanRS, CohenAN, . Increasing access to medications for opioid use disorder and complementary and integrative health services in primary care. J Gen Intern Med. 2020;35(Suppl 3):918–926.
34.
WyseJJ, GordonAJ, DobschaSK, . Medications for opioid use disorder in the Department of Veterans Affairs (VA) health care system: historical perspective, lessons learned, and next steps. Subst Abus. 2018;39(2):139–144.
35.
FiscellaK, WakemanSE, BeletskyL.Buprenorphine deregulation and mainstreaming treatment for opioid use disorder: X the X Waiver. JAMA Psychiatry. 2019;76(3):229–230.
WeimerM. Patients with opioid use disorder deserve trained clinicians: fiX the X waiver. Presented at the: AMERSA Conference. https://amersa.org/conference/conference-at-a-glance/. Published 2020. Accessed February 12, 2021.
SpetzJ, ToretskyC, ChapmanS, PhoenixB, TierneyM.Nurse practitioner and physician assistant waivers to prescribe buprenorphine and state scope of practice restrictions. JAMA. 2019;321(14):1407–1408.
40.
WenH, BordersTF, CummingsJR.Trends in buprenorphine prescribing by physician specialty. Health Aff. 2019;38(1):24–28.
41.
D'OnofrioG, O'ConnorPG, PantalonMV, . Emergency department–initiated buprenorphine/naloxone treatment for opioid dependence: a randomized clinical trial. JAMA. 2015;313(16):1636.
42.
Snell-RoodC, WillgingC, ShowalterD, PetersH, PolliniRA.System-level factors shaping the implementation of “hub and spoke” systems to expand MOUD in rural areas. Substance Abuse:1–17. Published online December 7, 2020. [epub ahead of print].
43.
SalonerB, LinL, SimonK.Geographic location of buprenorphine-waivered physicians and integration with health systems. J Subst Abuse Treat. 2020;115:108034.
