The American College of Medical Toxicology Strongly Recommends Removing Waiver for Prescribing Buprenorphine


July 29, 2019 — The American College of Medical Toxicology recently published a Position  Statement that strongly recommends removing the waiver (‘X-waiver’) requirement for prescribing buprenorphine for opioid use disorder (OUD). ACMT’s position has been endorsed by the American Academy of Clinical Toxicology, the American Academy of  Emergency Medicine, and the American College of Emergency Physicians. 

The Position states, “The ongoing epidemic of opioid overdose deaths represents a major public health crisis, with more than 48,000 Americans estimated to have died from opioid overdose in  2017 alone. Opioid use disorder (OUD) is a chronic medical condition that can be treated with pharmacological therapies. In response to growing evidence, there is consensus within the healthcare community that Opioid Agonist Therapy (OAT) is the best practice for the management of OUD. Therapy with buprenorphine, a form of OAT, reduces the risk of death in patients with OUD, prevents complications from nonfatal opioid overdose, prevents injection associated infections, improves overall functional status, and is cost-effective”.  

Currently, US law requires prescribers to obtain a waiver for outpatient prescription of buprenorphine, which is one of three medications approved to treat opioid addiction in the US.  Prescribers must complete an approved training and submit an application to the Substance  Abuse and Mental Health Services Administration. Once approved, the Drug Enforcement  Agency issues a registration number beginning with X (the so-called “x-waiver”) for outpatient prescribing of buprenorphine. Today, fewer than 5% of eligible prescribers in the US have a  waiver to prescribe buprenorphine. 

If the ‘X-waiver’ regulation is lifted, outpatient access to buprenorphine, a medication that has been demonstrated to be safe, cost-effective, and lifesaving, will positively affect patients with  OUD. 

Link to position statement.  

ACMT—Advancing the Toxicological Care of Poisoned Patients and Populations 
The American College of Medical Toxicology (ACMT) is a professional, nonprofit association of  physicians with recognized expertise and board certification in medical toxicology. Our members  specialize in the prevention, evaluation, treatment, and monitoring of injury and illness from  exposures to drugs and chemicals, as well as biological and radiological agents. ACMT  members work in clinical, academic, governmental, and public health settings, and provide  poison control center leadership.