Expert calls for reforms to address the overdose crisis

By Sondra Forsyth

In a Perspective piece published in the New England Journal of Medicine, the authors state that the federal government’s elimination of the “X waiver” at the end of 2022 was a significant step towards improving addiction treatment. The X waiver required physicians and other prescribers to undergo uncompensated training and obtain a special license, creating a regulatory barrier to offering buprenorphine treatment for opioid use disorder. While the elimination of the X waiver is a necessary step, it is not sufficient to achieve overdose-prevention goals, and more progress needs to be made.

Sarah Wakeman, a doctor who specializes in treating addiction, and Leo Beletsky, a lawyer and public health expert, suggest more actions should be taken to make sure people who need addiction treatment can access it. They recommend making buprenorphine treatment available through primary care doctors, expanding Medicaid coverage for addiction treatment, increasing funding for treatment and recovery services, and addressing the underlying social and economic factors that contribute to substance use disorders.

• Mainstreaming addiction education:The authors suggest adding education about addiction during medical school, residency, and other training programs, instead of just requiring an 8-hour training for clinicians who prescribe controlled substances.
• Expanding methadone access:Instead of requiring stable methadone patients to go to specialized clinics, allow them to receive their methadone treatment from their primary care doctor.
• Investing in the addiction treatment workforce: Sarah Wakeman, MD and Leo Beletsky, JD, MPH have suggested that the federal government should fund training programs which would include addiction medicine fellowship programs for physicians, and training in addiction programs for nurse practitioners, social workers, and mental health counselors.

Dr. Sarah Wakeman explained that the X waiver was a significant hurdle in providing necessary addiction treatment. Although it was eliminated, other barriers still exist, such as policies restricting access to harm-reduction services and methadone regulations. Dr. Wakeman and her co-author believe that the government needs to continue making progress in providing access to substance use disorder medication and rethinking methadone regulations.

Paper cited: Wakeman SE “Beyond the X — Next Steps in Policy Reforms to Address the Overdose Crisis” NEJM DOI: 10.1056/NEJMp2301479

About Mass General Brigham

Mass General Brigham is an integrated academic health care system, uniting great minds in medicine to make life-changing impact for patients in our communities and people around the world.

Mass General Brigham connects a full continuum of care across a system of academic medical centers, community and specialty hospitals, a health insurance plan, physician networks, community health centers, home care, and long-term care services. 

Mass General Brigham is a non-profit organization that is committed to patient care, research, teaching, and service to the community. In addition, Mass General Brigham is one of the nation’s leading biomedical research organizations and a principal teaching affiliate of Harvard Medical School. For more information, please visit massgeneralbrigham.or