Thread by @MarilynHeineMD

1/ @AmerMedicalAssn⁩ applauds
decision by ⁦@HHSGov⁩ to allow physicians to prescribe #buprenorphine without an X-waiver for the treatment of patients with #opioid use disorder. #OUD

However, it is important to keep in mind several considerations: ama-assn.org/press-center/a…

2/ •Use of #buprenorphine by a person who has #OUD but is not in withdrawal can precipitate withdrawal. This is a significant adverse experience. It also dissuades patients from adherence to treatment.

3/ •It is unclear whether removal of the X-waiver requirement for #buprenorphine-prescribing will increase access to care in the community. Already, physicians who have an X-waiver do not see the full allowed complement of patients who have #OUD.

4/ •Meaningful treatment of OUD involves more than medication alone. It is essential to ensure counseling to help patients develop effective coping skills. It is imperative to identify and manage underlying mental illness - a major driver of SUD - to attain and maintain recovery

5/ •To benefit ED patients, initiation of #buprenorphine in the ED must be coupled with a bridge to designated meaningful treatment for #OUD. @ACEPNow @Pacep4Em

6/ •#Buprenorphine’s effectiveness at managing the cravings felt by a person who has #OUD depends on the potency of the #opioid that the person is using. It is generally not adequate in the care of a person who uses #fentanyl. #Methadone is often necessary for these persons.

7/ •Elimination of the X-waiver requirement for #buprenorphine-prescribing does not address the #stigma of #OUD where NSDUH showed persons with #SUD were deterred from seeking care due to fear of exposure and associated known risk of losing job, housing, custody, and insurance.

8/ •Will the action by @HHSGov prompt patients to return to the ED as the primary access point for #buprenorphine management when the patient can't find an office based physician?

9/ •@samhsagov’s #buprenorphine treatment locator is of value to patients who seek #OUD care and pharmacies who check prescribers’ credentials. HHS’s action diminishes the utility of this resource.

10/ •The HHS guidance precludes a long term treatment relationship between the ED and the patient. But will patients return to the ED as the primary access point for #buprenorphine management when they can't find an office based physician? @ACEPNow @Pacep4Em

11/ •The emphasis on #buprenorphine prescribing discounts the importance of understanding #addiction, health effects of #OUD, or its chronicity and complexity.

12/ •It will be important to evaluate the effectiveness of this program and policy change. However, there is no defined entity or resources for data collection and evaluation. Lest the @OIGatHHS and @DEAHQ find this approach to be a focus of investigation for punitive purposes.