Making opioid addiction treatment more accessible

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In the fight against opioid addiction in the United States, one of the main tools used is a medication called buprenorphine. This drug is vital as it helps those struggling with addiction to reduce cravings and lowers the risk of fatal overdoses.

However, until recently, doctors and other medical professionals needed a special federal waiver, known as an “X waiver,” to prescribe it. This requirement was seen as a barrier that made it difficult for patients to access the medication.

On January 12, 2023, a significant change took place. The requirement for the X waiver was removed as part of a major federal budget bill.

This change allowed any medical professional with a license to prescribe controlled substances to also prescribe buprenorphine without needing special permission. This was expected to make it much easier for patients to get the help they needed.

Following this change, researchers from the University of Michigan conducted a study to examine the impact of removing the X waiver.

Their findings, published in the New England Journal of Medicine, revealed that the number of professionals prescribing buprenorphine did indeed increase significantly. By December 2023, over 53,600 clinicians were prescribing the medication, up from 42,100 the previous year.

Despite the increase in prescribers, the study found that the number of patients receiving buprenorphine didn’t see a similar rise. Throughout 2022, between 810,000 and 830,000 Americans were prescribed buprenorphine each month.

After the policy change in January 2023, these numbers showed little to no increase. This suggests that simply making the drug easier to prescribe wasn’t enough to significantly increase its use among patients.

The authors of the study, including Kao-Ping Chua, M.D., Ph.D., and Thuy Nguyen, Ph.D., noted a small uptick in the number of patients starting buprenorphine in January 2023.

By the end of the year, the number of new patients had increased slightly, indicating some positive effect from the policy change. However, this increase was not as substantial as hoped.

The researchers highlighted several potential reasons for the modest increase in patient numbers. There is still a stigma associated with treating opioid addiction, which can deter patients from seeking help.

Additionally, primary care and pain clinics, where such treatments could be administered, are often overwhelmed with other demands, making it challenging to integrate new treatments.

Prior to the removal of the X waiver, the federal government had made other attempts to improve access to buprenorphine during the COVID-19 pandemic.

These included allowing the drug to be prescribed via telehealth and easing some of the training requirements for prescribers. However, these measures had not led to a noticeable increase in the number of new patients using the medication.

The University of Michigan team, including researchers Amy Bohnert, Ph.D., and Pooja Lagisetty, Ph.D., also participated in the Michigan Opioid Collaborative.

This initiative, which started in 2017, aimed to help healthcare providers across Michigan increase the availability of buprenorphine.

The collaborative provided free consultations and training to healthcare professionals, which helped increase both the number of prescribers and patients in counties where the program was available.

This study underscores the complexity of addressing opioid addiction. While policy changes can help lower barriers to treatment, they are just one part of a larger puzzle.

Ongoing efforts, including public education, support for healthcare providers, and addressing stigma, are crucial to effectively combat this crisis.

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The research findings can be found in New England Journal of Medicine.

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