Training in medications for opioid use disorder and buprenorphine prescribing in the post X-waiver era: Insights from a nationwide, multispecialty survey.

objectiveThe January 2023 repeal of the X-waiver aimed to reduce regulatory barriers to buprenorphine prescribing and enhance patient access to medications for opioid use disorder (MOUD). Its impact on prescribing by non-addiction-trained physicians, the integration of MOUD training into residency programs, and the role of mandated training on clinical practice remain unclear.

methodsA 2024 online survey assessed physicians' awareness of the X-waiver repeal, exposure to MOUD training, and changes in buprenorphine prescribing. Multivariable logistic regression evaluated the independent effect of MOUD training and whether mandatory versus voluntary formats influenced prescribing behavior.

resultsAmong 959 physicians (42.7 % residents), 88.9 % endorsed the importance of treating patients with MOUD; yet 18.2 % were unaware of the repeal, and 16.8 % reported no MOUD training. Only 25.5 % of non-waivered physicians had initiated prescribing. Residents (28.8 % vs. 20.3 % among attendings; p = 0.02) and physicians in psychiatry (37.2 %), emergency medicine (36.8 %), and family medicine (32.8 %) were more likely to prescribe (p < 0.01). These differences were largely attenuated by MOUD training, which showed the strongest association with prescribing regardless of format.

conclusionsMOUD training, whether mandatory or voluntary, was significantly associated with buprenorphine prescribing. Standardizing training across specialties and institutions may improve buprenorphine uptake.