New federal guidelines will let almost all providers prescribe buprenorphine for opioid-use disorder, a boon to rural areas

The Department of Health and Human Services said Tuesday that it will allow most medical providers to prescribe buprenorphine for opioid-use disorder without first being trained and getting a waiver. "For years, many addiction physicians and public health advocates have argued that the 'X-waiver,' as the special buprenorphine license is known, poses a barrier to basic care for patients with opioid addiction," Lev Facher reports for Stat. "Many have argued that if a doctor can prescribe potentially addictive prescription pain drugs, they should also be able to prescribe the medicine used to treat the addiction."

Assistant Secretary for Health Rachel Levine said in the press release that increasing overdose deaths, especially during the pandemic, show the need for more access to medication-assisted treatments. Rural patients seeking such therapy can have a hard time accessing it because of transportation issues and the relative lack of qualified prescribers. But buprenorphine can be prescribed for a month at a time and taken at home, meaning rural patients don't have to travel so much, and can easily get it even at mobile clinics. About 40 percent of U.S. counties don't have a health-care who is approved to prescribe buprenorphine, an active ingredient in Suboxone, the preferred drug in medication-assisted treatment for substance-use disorder, according to a federal report.

"The move comes amid a worse-than-ever drug overdose crisis, which has taken a dire turn amid the Covid-19 pandemic," Facher reports. "More than 87,000 Americans died of overdoses during the 12-month period that ended in September 2020, according to estimates from the Centers for Disease Control. Data for the full 2020 calendar year isn’t available yet, but most addiction policy officials expect the death toll will climb even higher."

The clinicians with X-waivers "more than doubled between December 2017 and July 2020 . . . but more than half of small and remote rural counties lacked one," says the report of a study published in the Journal of Rural Health.