In a notice submitted to the Federal Register on Tuesday, Jan. 12, the U.S. Department of Health and Human Services announced that the agency would no longer require physicians to obtain a waiver to dispense buprenorphine, a drug used in medication-assisted treatment for opioid use disorder. This is a major policy shift that is expected to improve access to treatment for patients managing and recovering from opioid addiction.
According to the announcement, an exemption from the waiver requirement would have to meet the following criteria:
- Patients treated must be located in states where the physician is authorized to practice.
- The physician may treat no more than 30 patients with buprenorphine for opioid use disorder at one time (this does not apply to hospital-based, emergency room physicians).
- The physician must place an “X” on the prescription and clearly identify that the prescription is for an opioid use disorder.
- The physician must maintain charts separately for patients being treated with buprenorphine for opioid use disorder.
The waiver requirement, known as an X waiver, stems from the federal Drug Addiction Treatment Act (DATA) of 2000, as noted in this Health Affairs article calling for elimination of the waiver requirement. The bill was passed in an effort to move away from reliance on heavily regulated methadone clinics. As of January 2020, 327 physicians in Arkansas had an X waiver. Twenty-seven counties in Arkansas lacked a physician with an X waiver.
This is a welcome change for a state like Arkansas, where in 2018 providers wrote 93.5 opioid prescriptions for every 100 persons, compared to the average U.S. rate of 51.4 prescriptions per 100 persons, according to the National Institutes of Health. Nearly half of the 444 reported drug overdose deaths in Arkansas in 2018 involved opioids.
Arkansas has made strides in reducing the opioid prescription rate and dispensing of naloxone, an overdose drug, in recent years. According to a data analysis published by ACHI in September, among Medicaid and commercially insured beneficiaries in Arkansas, the number of individuals receiving opioid prescriptions decreased from fiscal year 2017 to fiscal year 2019, while the number of individuals receiving naloxone prescriptions increased.