Expert calls for reforms to address the overdose crisis

01/05/2023

At the end of 2022, the federal government eliminated the “X waiver,” a major hurdle to providing addiction treatment, but progress needs to be continued, according to the authors of a new Perspective piece published in the New England Journal of Medicine.

The X waiver required a special license and uncompensated training for physicians and other prescribers, creating a regulatory barrier to offering lifesaving buprenorphine treatment for opioid use disorder. Ending the X, the authors write, is necessary but not sufficient to achieve overdose-prevention goals.

Sarah Wakeman, MD, Medical Director for Substance Use Disorder at Mass General Brigham, and her co-author Leo Beletsky, JD, MPH, University of California, San Diego School of Medicine, call for several additional measures to expand access. These include:

Mainstreaming addiction education: Rather than the 8-hour training the Drug Enforcement Administration is now requiring of all clinicians who prescribe controlled substances, incorporate education about addiction during medical school, residency, and other training programs.
Expanding methadone access: Rethinking methadone regulations, including transitioning stable patients to office-based care with general practitioners.
Investing in the addiction treatment workforce: Federally fund training programs, including addiction medicine fellowship programs for physicians and training in addiction programs for nurse practitioners, social workers, and mental health counselors.

“The X waiver was one example of an onerous and unnecessary barrier to a lifesaving intervention, but there are many others, including methadone regulations and policies obstructing access to harm-reduction services,” said Wakeman. “We believe the federal government should continue its important progress in expanding access to medication for substance use disorder by rethinking methadone regulations.”

More information:
Sarah E. Wakeman et al, Beyond the X—Next Steps in Policy Reforms to Address the Overdose Crisis, New England Journal of Medicine (2023). DOI: 10.1056/NEJMp2301479

Journal information:
New England Journal of Medicine

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