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Comment & Response
August 3, 2021

X-Waiver Exemption in the Treatment of Opioid Use Disorder—Reply

Author Affiliations
  • 1Department of Medicine, Yale School of Medicine, New Haven, Connecticut
  • 2Department of Medicine, Harvard Medical School, Boston, Massachusetts
  • 3Grayken Center for Addiction, Boston University School of Medicine, Boston, Massachusetts
JAMA. 2021;326(5):442-443. doi:10.1001/jama.2021.8270

In Reply As we pointed out in our Viewpoint,1 racial disparities in access to MOUD are alarming and place Black, Hispanic/Latinx, Indigenous, Asian, Pacific Islander, and other racially oppressed and disenfranchised individuals at increased risk of opioid overdose and poor treatment outcomes.2 We agree with Mr Shearer and colleagues that addressing racism in the field of addiction treatment is critical to ensure equitable access to care. We believe that implementing structural changes such as the ones we proposed, including expanding all treatment options for OUD, acknowledging individuals’ social vulnerabilities within addiction treatment, reducing stigma, fixing archaic payment structures, and expanding health professions education in addiction, will be important simultaneous steps.1 Additionally, we support additions to research priorities within addiction medicine to specifically address structural racism and the criminalization of drug use.3 We applaud the decision of the Biden administration to reconsider the Department of Health and Human Services’ Practice Guidelines for the Administration of Buprenorphine for Treating Opioid Use Disorder, which was published on April 28, 2021. However, we believe it is a minor step forward, given stipulations for the ongoing use of the X-waiver on clinicians’ Drug Enforcement Administration numbers, patient limits, and use of separate records.4

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