Poster #123 - The Policy Impact of X-Waiver Elimination on Buprenorphine Access: Removing Barriers in Opioid Use Disorder Treatment

• In Event: Saturday Poster Luncheon

Abstract

The United States is in the midst of an opioid epidemic. There were 108,000 drug overdose deaths in the United States in 2022, and 82,000 of these deaths involved opioids. A major driver of this opioid epidemic is the widespread prevalence of opioid use disorders (OUD), which can be described as a chronic condition characterized by a compulsive use of opioid drugs. Buprenorphine (BP) is one of the preferred medications for opioid use disorder (OUD) treatment, shown to significantly reduce opioid overdose and opioid-related mortality risks. In 2000, the Drug Addiction Treatment Act (DATA) established the DATA-waiver (X-waiver) training requirement, mandating that prescribers should complete additional training before treating patients with OUD using buprenorphine. X-waiver requirement was repealed on December 29, 2022, through the Consolidated Appropriations Act with implementation starting in January 2023. This study assesses whether the elimination of the X-waiver in January 2023 improved buprenorphine access for individuals newly diagnosed with OUD in the US. It also investigates whether the removal of the X-waiver lessened racial and ethnic disparities in Buprenorphine access. Using data from the TriNetX database, a large real-world clinical data repository, we compare two cohorts of OUD patients diagnosed between February and June 2022 (pre-waiver) and February and June 2023 (post-waiver) to examine whether this regulatory change influenced buprenorphine prescribing trends and access disparities. Through OLS and logistic regressions, we find that patients in 2023 were 4.3% more likely to receive BP and received BP 43 days earlier on average. The initial analysis results also outline wide ranging ethnic disparities between white and other ethnicities in the US in BP access. Building on these initial results, our interaction term analysis reveals that the removal of the X-waiver had no significant impact in lessening ethnic disparities in BP access. We also conduct two robustness analysis to give greater weightage to our findings. First, we compare the February to June 2021 cohort of OUD patients with the February to June 2022 cohort of OUD patients to see any changes in BP prescribing trends before the X-waiver elimination. Second, we estimate Propensity Score Matching (PSM) estimates between our two initial analysis groups. Both the robustness checks give credence to our initial analysis results, which reveal that in contradiction to other recent literature on the topic, the removal of the X-waiver improved BP access, although it did not significantly impact disparities in BP access in the US, which would require more structural policy changes.

Author

• Shazib Altaf, Pennsylvania State University
  Presenting Author