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December 26, 2018

Buprenorphine Deregulation and Mainstreaming Treatment for Opioid Use Disorder: X the X Waiver

Author Affiliations
  • 1Departments of Family Medicine and Public Health Sciences, University of Rochester Medical Center, Rochester, New York
  • 2Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
  • 3School of Law and Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
  • 4University of California San Diego School of Medicine, La Jolla
JAMA Psychiatry. Published online December 26, 2018. doi:10.1001/jamapsychiatry.2018.3685

Buprenorphine, a partial opioid agonist medication for opioid use disorder (OUD), reduces overdose mortality rates.1 Yet, amidst a national epidemic of opioid-related deaths, 40% of the 2.4 million persons with OUD receive pharmacologic treatment, much less continue treatment.1 Federal policies surrounding buprenorphine constrain its wider use through separate US Drug Enforcement Agency (DEA)–amended licenses (“waivers”) after approved training.1 Removing buprenorphine prescribing regulations in France yielded increases in its use by persons with OUD.2 Notably, deaths from opioid overdoses in France declined 79% over the subsequent 3 years.2 If extrapolated to the United States, this translates to more than 30 000 fewer annual deaths from opioid overdoses. We propose deregulating the prescription of buprenorphine for treating OUD. We discuss the rationale for the current regulations, the evidence for deregulation, and a framework based on rational policies to ensure that deregulation achieves its intended purpose while minimizing consequences.

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