THE X FACTOR — Despite Congress’ lifting of the so-called X-waiver in a bid to make it easier for providers to prescribe buprenorphine to treat opioid use disorder, a new survey of more than 2,700 clinicians suggests myriad barriers remain. The analysis from researchers at the CDC, HHS and the Substance Abuse and Mental Health Services Administration explored how developing new practice guidelines — aimed at reducing educational burdens — to be able to prescribe the drug impacted prescribing habits. Congress later went further in the most recent omnibus spending package in December 2022 by eliminating the waiver required to prescribe. The findings: The researchers found that providers who became eligible under the eased 2021 guidelines were less likely to prescribe the lifesaving drug than providers who did so under the traditional guidelines, which required additional training. They also pointed to recent research showing that while the guidelines increased the number of providers eligible to prescribe, it didn’t lead to an increase in prescribing above historic trends. Those providers eligible to prescribe buprenorphine under the guidelines cited similar barriers to those under the old guidelines, including lack of patient demand, concerns about treating patients with opioid use disorder and insufficient institutional support, lead author Chris Jones of the CDC told Pulse. He argues that in the post-X waiver climate, in line with what happened after the practice guidelines were eased, it will be key to address other barriers, including reimbursement, workforce shortages and stigma. “Removing one barrier … did not diminish these other barriers,” he told Pulse. Why it matters: The researchers say the findings about the 2021 practice guidelines reinforce that removing the X-waiver won’t end other barriers to care, including DEA regulations, awareness, stigma and insurance requirements, among other things, as I previously reported. Nearly 110,000 people in the U.S. died of an overdose between February 2022 and February 2023. Reaction: Treatment advocates agree more needs to be done. Libby Jones, program director at the Overdose Prevention Initiative at the Global Health Advocacy Incubator, called for reauthorization of the SUPPORT Act, which tackles the opioid epidemic, along with added provisions to expand access to care for incarcerated people. Brian Hurley, president of the American Society of Addiction Medicine, called for Congress to boost funding for addiction medicine fellowships and reimbursement for comprehensive treatment. Bobby Mukkamala of the American Medical Association called for more research into the barriers, and Stephen Martin, head of research and education at Boulder Care, a treatment clinic, called for bolstering value-based payment arrangements for treatment. “Nothing is moving fast enough,” Martin said. WELCOME TO WEDNESDAY PULSE. How should the U.S. handle the opioid crisis going forward? Reach me at bleonard@politico.com with ideas, tips and more, and reach our usual host, Daniel, at dpayne@politico.com. TODAY ON OUR PULSE CHECK PODCAST, host Megan Messerly talks with Ben, who reports on the White House’s push to force health insurers to comply with a 2008 law meant to equalize mental and physical health benefits — and what it would mean for patient access and costs.
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