• Jiunling Janet Ho, Katie Fitzgerald Jones, Zachary Sager, Kyle Neale, Julie W Childers, Elizabeth Loggers, and Jessica S Merlin.
• Division of Palliative Medicine (J.J.H.), University of California, San Francisco and Addiction Medicine, Zuckerberg San Francisco General Hospital, San Francisco, California, USA. Electronic address: Janet.ho@ucsf.edu.
• J Pain Symptom Manage. 2022 Aug 1; 64 (2): 119127119-127.

ContextHospice and palliative care (HPC) clinicians increasingly care for patients with concurrent painful serious illness and opioid use disorder (OUD) or opioid misuse; however, only a minority of HPC clinicians have an X-waiver license or actively use it to prescribe buprenorphine as medication treatment for OUD.ObjectivesTo understand barriers for HPC clinicians to obtaining an X-waiver and prescribing buprenorphine as medication treatment for OUD.MethodsWe performed content analysis on 100 survey responses from members of the national Buprenorphine Peer Support Network, a group of HPC clinicians interested in buprenorphine, on X-waiver status, barriers to obtaining an X-waiver, and barriers to active prescribing.ResultsOf 100 HPC clinicians surveyed, only 26 of 57 HPC clinicians with X-waivers had ever prescribed. Prominent barriers included discomfort managing concurrent pain, buprenorphine, and OUD; concerns about impacts on practice; unsupportive practice culture; insufficient practice support; patient facing challenges; and cumbersome regulatory policies.ConclusionDespite HPC clinicians' interest in buprenorphine prescribing for OUD, several steps are needed to facilitate the practice, including clinician education tailored to pain and to clinical challenges faced by HPC clinicians, mentorship on buprenorphine use, and cultural and practice changes to dismantle systemic stigma towards addiction. We propose evidence-based steps derived from our survey findings that individual clinicians, HPC leaders, and national HPC organizations can take to improve care for patients with painful serious illness and OUD.Published by Elsevier Inc.

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