Mass General Brigham expert calls for reforms to address the overdose crisis

At the end of 2022, the federal government eliminated the “X waiver,” a major hurdle to providing addiction treatment, but progress needs to be continued, according to the authors of a new Perspective piece published in the New England Journal of Medicine. The X waiver required a special license and uncompensated training for physicians and other prescribers, creating a regulatory barrier to offering lifesaving buprenorphine treatment for opioid use disorder. Ending the X, the authors write, is necessary but not sufficient to achieve overdose-prevention goals.

Sarah Wakeman, MD, Medical Director for Substance Use Disorder at Mass General Brigham, and her co-author Leo Beletsky, JD, MPH, University of California, San Diego School of Medicine, call for several additional measures to expand access. These include:

• Mainstreaming addiction education: Rather than the 8-hour training the Drug Enforcement Administration is now requiring of all clinicians who prescribe controlled substances, incorporate education about addiction during medical school, residency, and other training programs.
• Expanding methadone access: Rethinking methadone regulations, including transitioning stable patients to office-based care with general practitioners.
• Investing in the addiction treatment workforce: Federally fund training programs, including addiction medicine fellowship programs for physicians and training in addiction programs for nurse practitioners, social workers, and mental health counselors.

“The X waiver was one example of an onerous and unnecessary barrier to a lifesaving intervention, but there are many others, including methadone regulations and policies obstructing access to harm-reduction services,” said Wakeman. “We believe the federal government should continue its important progress in expanding access to medication for substance use disorder by 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.org.