During pandemic, growth of clinicians with X-waivers for buprenorphine prescribing slowed

The growth in the number of clinicians with waivers to prescribe buprenorphine slowed during the pandemic, and support and mentorship are needed to facilitate obtaining a waiver, according to two studies published online May 12 in JAMA Network Open.

Joanne Spetz, Ph.D., from the University of California in San Francisco, and colleagues examined the number of clinicians with waivers to prescribe buprenorphine for opioid use disorder before and during the COVID-19 pandemic. The researchers found that 47,912 clinicians had waivers to prescribe buprenorphine in quarter (Q)2 of 2018 (84.3 percent physicians) compared with 99,481 clinicians in Q4 of 2021 (69.4 percent physicians). The number of waivers grew at a mean of 4,234 per quarter before the pandemic compared with 3,133 per quarter during the pandemic.

Holly J. Lanham, Ph.D., from the University of Texas Health Science Center San Antonio, and colleagues examined barriers and facilitators of obtaining an X-waiver and prescribing buprenorphine in a survey study conducted between September and December 2020. The researchers found that 48.4 percent of the 126 clinicians who responded had received an X-waiver; of these, 36 and 64 percent were and were not prescribing buprenorphine, respectively. Significantly different barriers among waivered and nonwaivered clinicians included the complexity of the X-waiver process, perceived lack of professional support and a referral network, and getting started. Significantly different barriers experienced by prescribers and nonprescribers were getting started and accessing reimbursement for treatment. Facilitators mentioned most frequently were changes to the waiver training and the need for networks connecting experienced clinicians with those starting out.

"Clinicians need ongoing support and mentorship from experienced and knowledgeable clinicians throughout the X-waiver and prescribing processes," Lanham and colleagues write.

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