By Jonathan Springston, Editor, Relias Media

The U.S. Department of Health and Human Services (HHS) has modified federal regulations to allow more physicians to prescribe buprenorphine and other medication-assisted treatment for opioid use disorder (OUD).

Under revised practice guidelines, physicians using this exemption will be limited to treating no more than 30 patients with buprenorphine for OUD at any one time. Notably, HHS did not apply this cap to hospital-based physicians, such as those who work in the ED. Physicians must place an "X" on prescriptions, clearly indicating the treatment is for OUD. A yet-to-be established working group will monitor these revisions and document results.

"Access to medication-assisted treatment, including buprenorphine that can be prescribed in office-based settings, is the gold standard for treating individuals suffering from opioid use disorder," Adm. Brett P. Giroir, MD, assistant secretary for health, said in a statement. "Removing some of the certification requirements for an X-waiver for physicians is a step toward providing more people struggling with this chronic disease access to medication-assisted treatment."

Previously, if physicians wanted to prescribe buprenorphine or other medication-assisted treatment outside opioid treatment programs, they had to take a course, apply to the DEA for an X-waiver, and wait weeks before receiving agency approval. “The X-waiver was an outdated and cumbersome barrier to treatment, and it exacerbated stigma for those struggling with opioid use disorder. Now, more than ever, we need compassion and action in treating patients with addiction,” Mark Rosenberg, DO, MBA, FACEP, president of the American College of Emergency Physicians (ACEP), said in a statement.

ACEP has called for an elimination to the X-waiver requirement. In 2020, ACEP rolled out a new accreditation program aimed at nudging EDs across the United States to up their game when it comes to both the treatment of pain and the way they manage patients who present with OUD. (Read more about the Pain and Addiction Care in the ED, or PACED, program in the November 2020 issue of ED Management.)

The American Medical Association (AMA) classified the X-waiver process as part of a “burdensome regulatory regime” that discouraged physicians from prescribing medication-assisted treatment. “Ensuring physician-led teams for treating patients with opioid use disorder is critical to ending the opioid epidemic. Removing the waiver requirement can also help lessen the stigma associated with this treatment and the persistent health disparities in treating substance use disorders,” Patrice Harris, MD, MA, chair of the AMA opioid task force, said in a statement.

Meanwhile, the authors of a recent study found women who receive treatment for a substance use disorder would welcome services that integrate their treatment with family planning and contraceptive services, as reported in the January issue of Contraceptive Technology Update. Additionally, the National Center for Complementary and Integrative Health, a division of the National Institutes of Health, is funding a multicenter study of the feasibility of offering acupuncture to patients who present to the ED complaining of pain and/or anxiety, as reported in the February issue of ED Management.

For even more relevant resources, check out the Rounds With Relias podcast series Episode 2, Opioid Diversion — Reducing Risks in Your Facility, and Episode 12, Provider Burnout When Treating Opioid Use Disorder.