WASHINGTON, DC — The American College of Emergency Physicians (ACEP) appreciates the Biden Administration’s effort to expand access to buprenorphine, a critical treatment for opioid use disorder (OUD). While the newly finalized guidelines take steps in the right direction for patients and clinicians, there are still barriers to treatment that these guidelines were unable to fully address.

The Biden Administration does not have the legal authority to repeal the X-waiver requirement for providing buprenorphine, but the new guidelines do allow practitioners to forgo some burdensome steps, including an 8-hour training course, currently required to obtain a waiver.  However, practitioners will still need to complete those requirements if they want to treat more than 30 patients at one time with buprenorphine.

Removing the X-waiver in its entirety and reducing barriers to treating opioid use disorder in the emergency department are major ACEP priorities.

“During the pandemic, the opioid epidemic has accelerated across the country and the number of overdose deaths has increased,” said Mark Rosenberg, DO, MBA, FACEP, president of ACEP. “Expanding patient access to Medication Assisted Treatment (MAT) in the emergency department is one of the most effective methods for addressing opioid use disorder or overdose. We urgently need federal action to slow these alarming trends and create more opportunities for emergency physicians to save lives — that starts with eliminating the X-waiver.”

Although the new guidelines address some administrative hurdles, the existence of the X-waiver contributes to misperceptions about MAT and fosters a stigma that leaves some clinicians hesitant to treat these patients.

“Even with these new practice guidelines, thousands of people will have a better chance at survival if it is easier for them to be treated from the emergency department,” said Dr. Rosenberg. “We need Congress to act by passing legislation like the Mainstreaming Addiction Treatment Act to fully repeal the X-waiver and make it easier for patients across the nation to access lifesaving treatment.”