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Expert calls for reforms to address the overdose crisis

In a Perspective piece published in the New England Journal of Medicine, the authors state that the federal government’s elimination of the “X waiver” at the end of 2022 was a significant step towards improving addiction treatment. The X waiver required physicians and other prescribers to undergo uncompensated training and obtain a special license, creating a regulatory barrier to offering buprenorphine treatment for opioid use disorder. While the elimination of the X waiver is a necessary step, it is not sufficient to achieve overdose-prevention goals, and more progress needs to be made.

Sarah Wakeman, a doctor who specializes in treating addiction, and Leo Beletsky, a lawyer and public health expert, suggest more actions should be taken to make sure people who need addiction treatment can access it. They recommend making buprenorphine treatment available through primary care doctors, expanding Medicaid coverage for addiction treatment, increasing funding for treatment and recovery services, and addressing the underlying social and economic factors that contribute to substance use disorders.

Dr. Sarah Wakeman explained that the X waiver was a significant hurdle in providing necessary addiction treatment. Although it was eliminated, other barriers still exist, such as policies restricting access to harm-reduction services and methadone regulations. Dr. Wakeman and her co-author believe that the government needs to continue making progress in providing access to substance use disorder medication and rethinking methadone regulations.

Paper cited: Wakeman SE “Beyond the X — Next Steps in Policy Reforms to Address the Overdose Crisis” NEJM DOI: 10.1056/NEJMp2301479

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