It will end in tiers: A strategy to include “dabblers” in the buprenorphine workforce after the X-waiver

Abstract

Buprenorphine is one of the gold standard medication treatments for opioid use disorder (OUD), with proven effectiveness in preventing overdose, increasing abstinence, and improving quality of life. In the United States, buprenorphine can be legally prescribed and administered in office-based settings from clinicians who are specially credentialed to provide that care under the X-waiver. We believe the X-waiver will ultimately be repealed, but there is a need for a variety of strategies to create a new treatment system after the X-waiver. Building a new tier of treatment capacity will require educational outreach, systems strategies, and enhanced payments.

Keywords:

• Buprenorphine
• quality of care
• access to care
• policy
• DATA 2000

Disclosure statement

The authors have no relevant conflicts of interest to disclose. The authors are solely responsible for the content of this article, which does not necessarily represent the official views of the US Federal Government, including the Department of Veterans Affairs, Veterans Health Administration and the National Institute of Health, National Institute on Drug Abuse.

Additional information

Funding

The authors acknowledge funding from National Institute on Drug Abuse [R01DA045800-01] (Stein, PI). Brendan Saloner also acknowledges funding from the National Institute on Drug Abuse [K01DA042139]. Barbara Andraka-Christou acknowledges funding from the Florida Supreme Court Office of the State Courts Administrator. Infrastructure support for author Gordon was provided, in part, by the VA HSR&D Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation [CIN 13-414] and the National Institute on Drug Abuse under the following award [NIH/NIDA 1UG1DA049444-01]. The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.