Are x‐waiver trainings enough? Facilitators and barriers to buprenorphine prescribing after x‐waiver trainings. Issue 2 (3rd February 2022)

• Record Type: Journal Article
• Authors: Gordon, Adam J.; Kenny, Marie; Dungan, Matthew; Gustavson, Allison M.; Kelley, A. Taylor; Jones, Audrey L.; Hawkins, Eric; Frank, Joseph W.; Danner, Anissa; Liberto, Joseph; Hagedorn, Hildi
• Is Part Of: American journal on addictions. Volume 31:Issue 2(2022)
• Page Start: 152
• Page End: 158
• Publication Date: 2022-02-03
• Subjects: Substance abuse -- Periodicals; Substance abuse -- Treatment -- Periodicals; 616.86005
• DOI: 10.1111/ajad.13260
• Languages: English
• ISSNs: 1055-0496

Abstract

Abstract: Background: In the United States, an x‐waiver credential is necessary to prescribe buprenorphine medication treatment for opioid use disorder (B‐MOUD). Historically, this process has required certified training, which could be a barrier to obtaining an x‐waiver and subsequently prescribing. To address this barrier, the US recently removed the training requirement for some clinicians. We sought to determine if clinicians who attended x‐waiver training went on to obtain an x‐waiver and prescribe B‐MOUD, and to examine what facilitated or impeded B‐MOUD prescribing. Methods: In September 2020, we conducted a cross‐sectional, electronic survey of attendees of 15 in‐person x‐waiver pieces of training from June 2018 to January 2020 within the Veterans Health Administration (VHA). Of the attendees ( n = 321), we surveyed current VHA clinicians who recalled taking the training. The survey assessed whether clinicians obtained the x‐waiver, had prescribed B‐MOUD, and barriers or facilitators that influenced B‐MOUD prescribing. Results: Of 251 eligible participants, 62 (24.7%) responded to the survey, including 27 (43.5%) physicians, 16 (25.8%) advanced practice clinicians, and 12 (19.4%) pharmacists. Of the 43 clinicians who could prescribe, 29 (67.4%) had obtained their x‐waiver and 16 (37.2%) had reported prescribing B‐MOUD. Prominent barriers to prescribing B‐MOUD included a lack of supporting clinical staff and competing demands on time. The primary facilitator to prescribing was leadership support. Conclusion and Scientific Significance: Nine months after x‐waiver training, two‐thirds of clinicians with prescribing credentials had obtained their x‐waiver and one‐third were prescribing B‐MOUD. Removing the x‐waiver training may not have the intended policy effect as other barriers to B‐MOUD prescribing persist.