Buprenorphine X-waiver exemption – beyond the basics for the obstetrical provider

Cleary, Erin M.; Smid, Marcela C.; Charles, Jasmin E; Jones, Kaitlyn M.; Costantine, Maged M.; Saade, George R.; Rood, Kara M.

doi:10.1016/j.ajogmf.2021.100451

Cited by 7 publications

(5 citation statements)

References 75 publications

(88 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…While the removal of some restrictions on the buprenorphine X-waiver was revisited in early 2021, there remain moderate institutional barriers to its widespread use. Specifically, the easement of certification restrictions is only beneficial for providers intending to use buprenorphine in the care of fewer than 30 patients [ 6 , 7 ]. Access to methadone as a treatment for OUD has historically not been covered by Medicare and has been more difficult to obtain; it can only be administered in opioid treatment programs (OTPs) and acute care settings in limited situations [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Demographic and Geospatial Analysis of Buprenorphine and Methadone Prescription Rates

Peterman¹,

Palsgaard²,

Vashi³

et al. 2022

Cureus

View full text Add to dashboard Cite

Background The medical community continues to seek to understand both the causes and consequences of opioid use disorder (OUD). The recent 2019 public release of the Automation of Reports and Consolidated Orders System (ARCOS) database from the years 2006 to 2012 provides a unique opportunity to analyze a critical period of the opioid epidemic with unprecedented data granularity. Objectives This study aims to use the ARCOS dataset to (1) determine significant contributory variables to opioid overdose death rates, (2) determine significant contributory variables to the relative prescription of buprenorphine and methadone, and (3) evaluate the existence of statistically significant geospatial clusters in buprenorphine and methadone prescription rates. Methods This study utilizes multiple databases, including the Centers for Disease Control and Prevention (CDC) Wide-ranging Online Data for Epidemiologic Research (WONDER), the Drug Enforcement Administration (DEA) prescription drug data, and the United States (US) Census demographics, to examine the relationship between the different treatments of OUD. Linear regressions are used to determine significant contributory factors in overdose rate and the buprenorphine-to-methadone ratio. Geospatial analysis is used to identify geographic clusters in opioid overdoses and treatment patterns. Results Methadone prescriptions, racial demographics, and poverty were found to significantly correspond to opioid overdose death rates (p < 0.05). Buprenorphine prescriptions were not found to be significant (p = 0.20). Opioid overdoses, metro character, racial categorization, and education were found to significantly correspond to the ratio of buprenorphine to methadone prescribed (p < 0.05). Cluster analysis demonstrated different geospatial distributions in the prescriptions of buprenorphine and methadone (p < 0.05). Conclusion Historically, methadone prescriptions have been higher in areas with high overdose rates. Buprenorphine and methadone prescribing patterns have historically demonstrated different geographic trends.

show abstract

Section: Introductionmentioning

confidence: 99%

Demographic and Geospatial Analysis of Buprenorphine and Methadone Prescription Rates

Peterman¹,

Palsgaard²,

Vashi³

et al. 2022

Cureus

View full text Add to dashboard Cite

show abstract

“…[21,22]Acknowledging and filling in this gap in knowledge through X-waiver training course plays a critical role in expanding access to MOUD. [23,24] Feedback from our participants also found the need for practitioners to practice their knowledge and improve confidence with prescribing buprenorphine. Thus, a structured learning environment, including a mixture of training modules and practice, is critical to prepare practitioners to assess and treat patients with OUD.…”

Section: Changes To Practitioners' Perceptionsmentioning

confidence: 93%

Impact of Virtual X-waiver Training on Perceptions of Barriers and Facilitators to Medications for opioid Use Disorder

2023

J Addict & Prev

View full text Add to dashboard Cite

Background: DATA 2000 X-waiver training has existed for over 20 years, however, less than 10% of eligible practitioners have been waivered. The purpose of this study was to understand practitioners' perceptions of X-waiver training and to assess the feasibility of virtual X-waiver training.Methods: Three separate virtual X-waiver training courses were provided from December 2020 through September 2021. Pre-and posttraining surveys were developed to understand practitioners' attitudes toward patients with opioid use disorder (OUD) and to evaluate the effect of the training. All participants were invited to complete surveys anonymously via Qualtrics.Results: Among 168 participants, 140 and 133 completed pre-and post-training surveys, respectively. Analysis of the pre-training survey data showed that 80% of practitioners were willing to treat patients with OUD. Post-training responses documented significant improvements in diagnosing OUD and recognizing opioid withdrawal symptoms. Similarly, post-training results showed 96% of respondents noted improved confidence in their capacity to prescribe buprenorphine. Approximately 69% of respondents in the pre-training survey were not aware of local community resources to refer patients for substance use treatment; this was reduced to 34% in post-training responses. Postsurvey qualitative data revealed that participants thought the virtual training was efficient, however, suggested more in-person interaction and lecture-based discussion. In addition, respondents continued to report persistent barriers to implementation of buprenorphine prescribing. Conclusion:This study demonstrated the feasibility of delivering X-waiver training virtually. In addition, X-waiver training improved practitioners' knowledge and comfort in identifying and managing OUD although persistent barriers to buprenorphine prescribing remain despite training.their patients with OUD due to a variety of reasons, including but not limited to, stigma associated with this patient population and lack of training and expertise.[8-10] Thus, it is not surprising that in Jefferson County, the most populous county in Alabama, less than 20% of eligible patients receive evidence based MOUD. [7] Taking this into account, educating practitioners, assisting waivered practitioners in delivering MOUD, and expanding MOUD training to include nonaddiction medicine physicians is urgently needed to increase capacity to treat patients with OUD in Alabama.To address the overwhelming need, the University of Alabama at Birmingham (UAB) was awarded a grant through the Foundation for Opioid Response Efforts to provide X-waiver training to practitioners primarily at UAB Hospital and Cahaba Medical Care Foundation using a multidisciplinary approach. UAB Hospital is the largest medical center in the Southeast region, and Cahaba Medical Care Foundation is a Federal Qualified Health Clinic (FQHC), also located in Jefferson County, Alabama, serving over 20,000 patients annually. The educational objectives were: (1) to understand the pract...

show abstract

“…From 1999 to 2014, the rate of OUD complicating birth has increased by more than 4-fold and in some states the rate has increased nearly 10-fold, yet OUD treatment is still stigmatized and underutilized ( 8 , 52 ). Despite public health and professional society recommendations supporting MOUD ( 14 ), pregnant and postpartum individuals with OUD continue to face barriers to treatment, including stigma ( 53 ), discrimination, lack of knowledgeable clinicians ( 54 ), and misinformation about NAS ( 55 ). Available data regarding negative fetal effects of opioids are inconsistent and some of the literature is cross-sectional, retrospective (hence subject to recall and other bias), or outcome assessments are not masked.…”

Section: Opioidsmentioning

confidence: 99%

Principles of care for pregnant and parenting people with substance use disorder: the obstetrician gynecologist perspective

Barber

Terplan

2023

Front. Pediatr.

View full text Add to dashboard Cite

Substance use in pregnant and parenting persons is common, yet still underdiagnosed. Substance use disorder (SUD) is one of the most stigmatized and undertreated chronic medical conditions, and this is exacerbated in the perinatal period. Many providers are not sufficiently trained in screening or treatment for substance use, so gaps in care for this population persist. Punitive policies towards substance use in pregnancy have proliferated, lead to decreased prenatal care, do not improve birth outcomes, and disproportionately impact Black, Indigenous, and other families of color. We discuss the importance of understanding the unique barriers of pregnancy-capable persons and drug overdose as one of the leading causes of maternal death in the United States. We highlight the principles of care from the obstetrician-gynecologist perspective including care for the dyad, person-centered language, and current medical terminology. We then review treatment of the most common substances, discuss SUD during the birthing hospitalization, and highlight the high risk of mortality in the postpartum period.

show abstract

Buprenorphine X-waiver exemption – beyond the basics for the obstetrical provider

Cited by 7 publications

References 75 publications

Demographic and Geospatial Analysis of Buprenorphine and Methadone Prescription Rates

Demographic and Geospatial Analysis of Buprenorphine and Methadone Prescription Rates

Impact of Virtual X-waiver Training on Perceptions of Barriers and Facilitators to Medications for opioid Use Disorder

Principles of care for pregnant and parenting people with substance use disorder: the obstetrician gynecologist perspective

Contact Info

Product

Resources

About