The Removal Of The X-Waiver: What It Means For Pain Medicine Practitioners

It is now easier to prescribe buprenorphine to patients with opioid use disorders.

During the recent State of the Union address, President Joe Biden mentioned a law that simplifies prescribing opioid addiction treatments. He was referring to the X-Waiver, which had been around for over 20 years before it was done away with on December 29, 2022.

“With the signing of the Consolidated Appropriations Act of 2023, Congress eliminated the DATA-Waiver Program,” states the Drug Enforcement Administration (DEA)’s website. “The elimination of the X-Waiver will increase access to buprenorphine for those in need.” 

With the waiver, doctors had to jump through multiple hoops (training, audits, a patient limit) if/when they prescribed the drug. Therefore, as the vice president for research at UT Health San Antonio, Jennifer Potter, told NBC News, health professionals had been waiting for its removal for “years if not a decade or more.”

Dr. Michael Sprintz is an expert on addiction and chronic pain, as he personally overcame opioid and alcohol addiction and founded the Sprintz Center for Pain and Recovery. He provided the Texas Pain Society with further details on the removal of the X-Waiver, including what it means for pain medicine professionals in Texas. 

“Every pain practice has at least some chronic pain patients with a substance use disorder (SUD), whether or not they know it,” Dr. Sprintz shared. “Knowing the basics on how to identify and how to help patients who may have a SUD /opioid use disorder (OUD) is vital to prevent avoidable patient harm and decrease providers’ medicolegal risk.”

Because of the elimination:

• Physicians and other prescribers no longer need a separate DEA X-waiver license to prescribe buprenorphine for patients with opioid use disorder.

• All prescriptions for buprenorphine only require a standard DEA registration number, and the previously used DATA-Waiver registration numbers are no longer needed for any prescription.

• There are no longer any limits or patient caps on the number of patients a prescriber may treat for opioid use disorder with buprenorphine.

Dr. Sprintz went on to explain how this is helpful for physicians and patients alike – especially in the midst of the opioid epidemic. “The DEA’s decision to remove the X-Waiver requirement is an important and positive step in providing much greater patient access to providers and medications to treat opioid use disorder and patients with physiologic opioid dependence needing to discontinue opioids.

“The old methods of tapering down a certain percentage every week or two often left patients in a state of persistent, low-level opioid withdrawal throughout the entire tapering process, which worsened the pain experience and increased the likelihood of failing the taper. The other, unfortunately, common practice of simply discharging patients left many in full-blown withdrawal. Many patients might find another provider, but some ended up resorting to buying opioids on the street to avoid withdrawal and ended up unintentionally overdosing and dying.

“When it comes to professional responsibility when prescribing a medication, opioids are the same as every other prescription medication. That is, we have a responsibility to know how a drug works and the appropriate dosage to treat the condition for which we are prescribing it. It’s also our responsibility to understand the risks, side effects, and potential complications of opioid use and, most importantly, have the knowledge and competency to manage those complications. 

“Removal of the DEA requirements for buprenorphine prescribing expands the options pain providers have when tapering patients off opioids for whom the benefits of opioids no longer outweigh the risks.”

When it comes to the removal of the X-Waiver, health professionals should also keep in mind:

• The Act does not impact existing state laws or regulations that may be applicable.

• There will be new training requirements for ALL prescribers of controlled substances.

• The DEA noted that another section of the Act, the Medication Access and Training Expansion (MATE) Act, also introduced new training requirements for all prescribers of controlled substances, which include an eight hour training in identifying and treating addiction when a practitioner applies for or renews their DEA registration to prescribe controlled substances. This requirement will go into effect on June 21, 2023.

• Even though you no longer need the X-Waiver to prescribe buprenorphine, every doctor (yes, including YOU) will need to get training in identifying and treating addiction as a requirement to renew their DEA license. 

“The reality is that the fields of pain medicine and addiction medicine are converging,” Dr. Sprintz finished. “Both specialties require core knowledge and competencies from the other. For pain docs who prescribe any opioids, it’s important to know the basics on identifying patients with possible OUD, and for any of their patients on opioids, it’s imperative to know how to safely and effectively manage opioid withdrawal.”