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Exciting news for advocates to #XtheX Waiver today to loosen restrictions for buprenorphine access.
However, still a lot of unanswered questions and still doesn't go far enough.
A thread (
) and check out release here: https://www.hhs.gov/about/news/2021/01/14/hhs-expands-access-to-treatment-for-opioid-use-disorder.html
However, still a lot of unanswered questions and still doesn't go far enough.
A thread (
) and check out release here: https://www.hhs.gov/about/news/2021/01/14/hhs-expands-access-to-treatment-for-opioid-use-disorder.html
1) Advocates have been saying for YEARS that requiring additional training and a special waiver (known as the X waiver) to prescribe buprenorphine (a lifesaving treatment for opioid addiction), means less prescribers and less access for patients.
2) This new change applies ONLY to MDs who already have a DEA waiver.
LEFT OUT: Nurse practitioners (NPs), physician assistants (PAs), certified nurse certified nurse specialists (CNSs), certified registered nurse anesthetist (CRNAs), & certified nurse midwives (CNMs)
LEFT OUT: Nurse practitioners (NPs), physician assistants (PAs), certified nurse certified nurse specialists (CNSs), certified registered nurse anesthetist (CRNAs), & certified nurse midwives (CNMs)
3) The other providers will STILL NEED to complete training and apply for the waiver in order to prescribe buprenorphine for opioid use disorders. And in many rural counties across the US, NPs and PAs are more active prescribers https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2019.00859
4) The MDs who can now prescribe buprenorphine are also still limited to HOW MANY patients they can start prescribing to.
According to the new change, an MD may prescribe and maintain 30 patients on buprenorphine on their case load.
Yes, 30. Just 30.
According to the new change, an MD may prescribe and maintain 30 patients on buprenorphine on their case load.
Yes, 30. Just 30.
5) This new policy does NOT apply to a doctor's ability to prescribe methadone for opioid use disorder, the gold-standard medication treatment for OUD with decades of research evidence.
6) These new prescribing doctors will have to create a new system for organizing their client charts and files because according to federal laws, opioid use disorder treatment records are held to different standards of confidentiality.
7) The "devil" will also be in the implementation of these new changes on the ground. Implementation science tells us that new guidelines mean little unless appropriate guidance, dissemination, and support is provided on the ground to see this changes through.
8) The other challenges include the fact that, while buprenorphine is an amazing medicine, it is a bit tricky to get patients initiated onto it comfortably if they are currently using illicit fentanyl and trying to transition off. They will need education and support.
9) We also know that many doctors will need address their own stigma and challenges around working with patients with opioid use disorder.
A recent study of MDs with the X waiver found that most doctors are not prescribing to the fullest extent possible https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2769683
A recent study of MDs with the X waiver found that most doctors are not prescribing to the fullest extent possible https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2769683
10) There is a possibility that with more providers, we may be able to better serve communities of color. Maybe??
A recent study found that Black patients are 70% less likely to be offered buprenorphine for opioid use disorder than white patients. http://jamanetwork.com/journals/jamapsychiatry/fullarticle/2732871
A recent study found that Black patients are 70% less likely to be offered buprenorphine for opioid use disorder than white patients. http://jamanetwork.com/journals/jamapsychiatry/fullarticle/2732871
11) We also still have to consider that a prescription only works if it is filled. This new roll out will need to be accompanied by greater buprenorphine availability in pharmacies and changes must be clearly explained to pharmacists for buy-in: https://doi.org/10.1080/08897077.2019.1616349
12) There are other factors to consider, but I think this is a little preview of some of the potential for increasing access to this incredible medication, but also some ongoing considerations and challenges that will remain.
Let's remember, we need to #FreeMethadone too!
FIN.
Let's remember, we need to #FreeMethadone too!
FIN.
