• Nicholas LeFevre, St LouisJoshuaJFrom the Department of Family and Community Medicine, University of Missouri-Columbia, Columbia, MO; Department of Family Medicine, Tufts University School of Medicine, Core Faculty, Lawrence Family Medicine Residency, Lawrence, MA (JSL); R, Emma Worringer, Morgan Younkin, Natalie Stahl, and Mia Sorcinelli.
• From the Department of Family and Community Medicine, University of Missouri-Columbia, Columbia, MO; Department of Family Medicine, Tufts University School of Medicine, Core Faculty, Lawrence Family Medicine Residency, Lawrence, MA (JSL); Rush-Esperanza Family Medicine Residency, Chicago, IL (EW); Harm Reduction Services, Boston Health Care for the Homeless Program, Clinical Assistant Professor, Department of Family Medicine, Tufts University School of Medicine, Boston, MA (MY); Department of Family Medicine, Tufts University School of Medicine, Addiction Consult Service, Lawrence General Hospital, Community Faculty, Lawrence Family Medicine Residency, Lawrence, MA (NS); Office Based Addiction Treatment Program, Greater Lawrence Family Health Center, Community Faculty, Lawrence Family Medicine Residency, Lawrence, MA (MS). nlefevre@health.missouri.edu.
• J Am Board Fam Med. 2023 Oct 11; 36 (5): 867872867-872.

AbstractWith the passage of the MAT act (Mainstreaming Addiction Treatment) and the MATE Act (Medication Training and Expansion), the Drug Enforcement Agency "X-waiver" program governing the office-based prescription of buprenorphine for opioid use disorder has been immediately eliminated. The move was championed by vocal organizations with a rightful concern about buprenorphine access but was opposed by most physicians. Nonetheless, buprenorphine can now be prescribed like any schedule 3 medication. Studies show that despite rising opioid overdoses, buprenorphine prescription increases have been slow to rise and are particularly absent in rural communities. The elimination of the X-waiver may theoretically improve buprenorphine prescribing rates for opioid use disorder in rural areas, by nurse practitioners and physician assistants, and by resident physicians in teaching programs. It may also help decrease discrimination against individuals with opioid use disorder in postacute-care settings like nursing homes, physical rehabilitation centers, and in prisons and jails. Concerns include the elimination of the only focused opioid use disorder education many physicians receive (X-waiver courses) and a literature base showing that interest, rather than the X-waiver itself, remains the biggest barrier to recruiting more buprenorphine prescribers. Concerns also exist over the harms of precipitated withdrawal when buprenorphine is initiated inappropriately. The change of the elimination of the X-waiver brings about a new opportunity for Family Medicine and its parent organizations to champion the inclusion of opioid use disorder treatment within the chronic disease care models well-known to our integrated care settings.© Copyright by the American Board of Family Medicine.

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