Eliminate the buprenorphine DEA X waiver: Justification using a policy analysis approach

Abstract

Introduction Drug overdoses have reached a historic milestone of over 100,000 deaths in a single year, 75,673 related to opioids. The acceleration in opioid‐related deaths coupled with stark health inequities demands a close examination of opioid use disorder (OUD) treatment barriers and swift consideration of policy changes. Design The aim of this buprenorphine policy analysis is to summarize existing buprenorphine barriers and present policy solutions to improve access and actualize the contributions of Advanced Practice Registered Nurses (APRNs). Methods The policy analysis follows five sequential steps: (1) defining the problem, (2) identifying key stakeholders, (3) assessing the landscape of relevant policies, (4) describing viable policy options, and (5) making final recommendations. Results Although there are laudable efforts to improve buprenorphine access, such as the new buprenorphine guidelines issued in April 2021, without larger‐scale changes to federal, state, and scope of practice laws, overdose rates will continue to rise. We recommend a multipronged policy approach to improve buprenorphine treatment access, including eliminating the DEA X waiver, improving OUD education, and adopting full practice authority for APRNs in all states. Conclusion Incremental change is no longer sufficient to address opioid overdose deaths. Bolder and coordinated policy action is possible and necessary to empower the full clinical workforce to apply evidence‐based life‐saving treatments for OUD. The critical contributions of nurses in advancing equitable access to OUD care are emphasized in the National Academy of Medicine's Report, Future of Nursing: Charting a Path to Achieve Health Equity. Nurses are named as instrumental in improving buprenorphine access. Policy changes that acknowledge and build on evidence‐based treatment expansion strategies are sorely needed. Clinical Relevance One of the most robust tools to combat opioid overdose deaths is buprenorphine, a partial opioid agonist, and gold standard medication treatment for OUD, but only 5% of the prescribing workforce possess the required Drug Enforcement Agency (DEA) X waiver. A growing body of evidence demonstrates that Advanced Practice Registered Nurses are accelerating the growth in waiver update and buprenorphine use, despite the considerable barriers and limitations described in this policy analysis.

Ensuring Advanced Practice Nursing Students Meet the 2023 Drug Enforcement Agency Requirements

“…In recent years, health care clinicians and public health advocates made the case for expanding access to OUD treatment by eliminating the special DEA requirement to prescribe buprenorphine. [12][13][14][15] In 2023, the passage of the Consolidated Appropriations Act resulted in the revocation of that special requirement. 16 As a result, all DEA-registered providers became eligible to prescribe buprenorphine, albeit with a onetime 8-hour training requirement on treating and managing patients with substance use disorders.…”

“…In recent years, health care clinicians and public health advocates made the case for expanding access to OUD treatment by eliminating the special DEA requirement to prescribe buprenorphine 12-15. In 2023, the passage of the Consolidated Appropriations Act resulted in the revocation of that special requirement 16.…”