During the pandemic, the growth of physicians with X exemptions for buprenorphine prescriptions has slowed

Growth in the number of physicians with exemptions to prescribe buprenorphine has slowed during the pandemic, and support and guidance are needed to make it easier to obtain exemption, according to two studies published online May 12 in JAMA network is open.

Dr. Joanne Spitz of the University of California, San Francisco, and colleagues examined the number of physicians who had exemptions to prescribe buprenorphine for opioid use disorder before and during the COVID-19 pandemic. The researchers found that 47,912 physicians were granted exemptions for prescribing buprenorphine in Q2 of 2018 (84.3 percent of physicians), compared with 99,481 physicians in the fourth quarter of 2021 (69.4 percent of physicians). The number of exemptions grew by an average of 4,234 per quarter before the pandemic compared to 3,133 per quarter during the pandemic.

Holly J. Lanham, Ph.D., of the University of Texas Health Science Center at San Antonio, and colleagues examined barriers and facilitators for obtaining an X waiver and prescribing buprenorphine in a survey conducted between September and December 2020. Researchers found that 48.4 percent of the 126 physicians who responded had on the assignment of X; Of these, 36 and 64 percent were and were not prescribing buprenorphine, respectively. Significantly different barriers between waived and untreated clinicians included the complexity of the X-waiver process, perceived lack of professional support and referral network, and initiation. The exponentially different barriers faced by prescribers and non-prescribers began with obtaining compensation for treatment. Facilitators often mentioned changes in exemption training and the need for networks linking experienced physicians with junior physicians.

“Physicians need the ongoing support and guidance of experienced and knowledgeable clinicians throughout the waiver and prescription processes,” Lanham and colleagues write.

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