• Holly Ann Russell, Mechelle Sanders, Jessica K V Meyer, Elizabeth Loomis, Teraisa Mullaney, and Kevin Fiscella.
• From the Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY (HAR); Department of Family Medicine, United Memorial Medical Center, Batavia, NY (EL); Department of Family Medicine, University of Rochester Medical Center, Rochester, NY (MS, KF); University of Rochester School of Medicine and Dentistry, Rochester, NY (TM, JKVM). Holly_russell@urmc.rochester.edu.
• J Am Board Fam Med. 2021 Nov 1; 34 (6): 1212-1215.

BackgroundSubstance use disorders, including opioid use disorder (OUD), are understood as chronic diseases with a relapsing and remitting course and no known cure. Medications for OUD (MOUD) are well established with decades of evidence supporting their safety and efficacy; however, treatment access remains poor and inequitable. Buprenorphine is an MOUD that can be prescribed in a primary care outpatient setting, although regulatory and administrative challenges are a barrier to prescribing it. Recent regulatory changes offer an opportunity to expand the number of family doctors who treat OUD.MethodsWe offered free, easily accessible buprenorphine "x-waiver training" led by a team of primary care clinicians. In addition, we provided wrap-around support for MOUD clinical questions and administrative needs with experienced family medicine mentors.ResultsMore than 400 clinicians attended our trainings, including medical students, residents, and attending physicians. Of the 101 attending physicians who completed our trainings, only 30 went on to apply for an x-wavier, and of those only 7 were currently prescribing when contacted 12 months later.ConclusionOur experience indicates that removing the training requirement is a necessary first step but is unlikely to result in major changes to rates of prescribing without other significant cultural changes.© Copyright 2021 by the American Board of Family Medicine.

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