Relaxation Of Prescriber Training Requirements Did Not Increase Use Of Buprenorphine

Relaxing prescriber training requirements for buprenorphine to treat opioid use disorder (OUD) was not associated a year later with an increase in the number of clinical professionals who prescribed it or the number of consumers with OUD who received a prescription. This observation was noted in a study of prescribing trends in four states during the year before, and the year after, April 2021 when the federal government relaxed training requirements for health care professionals to obtain an X waiver to prescribe buprenorphine.

The study focused on trends in 33 urban and rural communities in Kentucky, Massachusetts, New York, and Ohio. The outcomes were as follows:

• In three of the four states, the number of X-waivered clinical professionals increased: by 5.2% in Massachusetts communities, 6.4% in New York communities, and 8.4% in Kentucky communities. In Ohio, the number decreased by 0.5%.
• In Kentucky, the number of X-waivered clinical professionals prescribing buprenorphine to more than one person increased by 3.2%. However, in the other three states, there was no change or was a decrease in the number of eligible prescribers actually prescribing buprenorphine. In Massachusetts, it declined by 3.8%; and in Ohio, it declined by 6.9%. There was no applicable data for New York.
• The number of consumers actually receiving a buprenorphine prescription increased by 1.7% in Massachusetts but declined by 1.5% in Kentucky and by 2.3% in Ohio. There was no applicable data for New York.

These findings were reported in “Buprenorphine Prescribing Characteristics Following Relaxation of X-Waiver Training Requirements” by Paul J. Christine, M.D., Ph.D.; Rouba A. Chahine, Ph.D., MS; Simeon D. Kimmel, M.D., MA; and colleagues. The researchers analyzed data from the HEALing Communities Study (HCS) for 2020 through 2022. The HCS was a cluster-randomized, wait-list controlled trial conducted by the National Institutes of Health from 2019 through December 31, 2023, to test addiction prevention and treatment implementation strategies. In total, 67 communities in the four states participated in the HCS. The 33 communities included in this study had been waiting to participate in the HCS.

The researchers compared buprenorphine treatment trends in the 33 communities before and after the federal training requirements were lifted. For each community, the researchers tracked the monthly number of clinical professionals with an X waiver, the number of buprenorphine prescribers, and the number of people receiving buprenorphine prescriptions. The goal was to determine the effect of the federal policy change.

The full text of “Buprenorphine Prescribing Characteristics Following Relaxation of X-Waiver Training Requirements” was published August 5, 2024, by JAMA Network Open. A free abstract is available online at https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2821949 (accessed August 29, 2024).

OPEN MINDS last reported on this topic in the following articles:

• “61% Of Americans Unaware That Primary Care Professionals Can Prescribe Addiction Treatment Medications,” which published on July 15, 2024, at https://openminds.com/market-intelligence/news/61-of-americans-unaware-that-primary-care-professionals-can-prescribe-addiction-treatment-medications/
• “No National Rise In Buprenorphine Prescribing In First Year After Loosening Prescribing Rules,” which published on June 11, 2024, at https://openminds.com/market-intelligence/news/no-national-rise-in-buprenorphine-prescribing-in-first-year-after-loosening-prescribing-rules/

For more information, contact: Paul J. Christine, M.D., Ph.D., Assistant Professor, Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, 12631 East 17th Avenue, 8th Floor, Academic Office 1, Mailstop B180, Aurora, Colorado 80045; Email: paul.christine@cuanschutz.edu; Website: https://som.cuanschutz.edu/Profiles/Faculty/Profile/38190