Rapid Clinical Updates: Hospitalist Management of Opioid Use Disorder-X-Waiver FAQs

X-Waiver FAQs

Pdf Summary

On April 28, 2021, the U.S. Department of Health and Human Services released new guidelines to ease prescribing buprenorphine, a medication effective in treating Opioid Use Disorder (OUD). Previously, clinicians needed an X-Waiver involving 8 to 24 hours of training to prescribe buprenorphine, a requirement completed by only 5% of U.S. providers, limiting patient access especially in rural areas. Hospitalists could start buprenorphine during hospitalization without a waiver but couldn’t prescribe it at discharge to bridge outpatient care.<br /><br />The new guidelines exempt physicians, nurse practitioners, physician assistants, and certain advanced practice nurses from completing training if they submit a Notification of Intent (NOI) to SAMHSA, allowing them to prescribe buprenorphine to up to 30 patients simultaneously. To treat more than 30 patients, traditional X-Waiver training remains necessary. Eligible clinicians must be licensed under state law, have a valid DEA registration, and comply with state supervision regulations.<br /><br />This change is significant for hospitalists because hospitalization offers a critical opportunity to initiate buprenorphine treatment. Being able to prescribe at discharge with the waiver exemption helps patients continue treatment in the community, reducing overdose deaths. The 30-patient cap is considered a reasonable starting point for hospitalists integrating OUD treatment into practice.<br /><br />The Society of Hospital Medicine (SHM) supports these changes by providing education, advocating for removal of remaining waiver barriers, and clarifying the new patient limit’s impact on hospitalists. Clinicians interested can submit their NOI via SAMHSA’s website using their DEA number and state license details.<br /><br />This reform aims to dismantle stigma, increase access to life-saving treatment, and empower hospitalists and other providers to expand outpatient buprenorphine therapy for patients with OUD.

Keywords

Buprenorphine prescribing guidelines

Opioid Use Disorder treatment

X-Waiver exemption

Notification of Intent (NOI)

Hospitalists and buprenorphine

SAMHSA regulations

DEA registration requirements

30-patient prescribing limit

Society of Hospital Medicine (SHM)

Outpatient OUD therapy