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Comment & Response
August 3, 2021

X-Waiver Exemption in the Treatment of Opioid Use Disorder

Author Affiliations
  • 1Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis
  • 2Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, Minnesota
  • 3SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, Connecticut
JAMA. 2021;326(5):441-442. doi:10.1001/jama.2021.8267

To the Editor We agree with the recent Viewpoint1 suggesting that exemption to the X-waiver, while an important step to increase access to buprenorphine, likely will not sufficiently address barriers to access of medications for opioid use disorder (MOUD). The Viewpoint authors acknowledged both disparities in access to MOUD and in overdose deaths, especially among rural communities and Black individuals. However, it is unclear if increased physician education and reduced regulatory barriers for physicians prescribing MOUD will address these discrepancies. Moreover, we are concerned that policy changes that increase the number of buprenorphine prescribers without addressing the structural causes of these disparities may have the unintended consequence of reinforcing or increasing them.