President Biden approved the elimination of the DATA Waiver (X-Wavier) requirement and several other prescribing practice changes when he signed Dec. 29 the Consolidated Appropriations Act, 2023. Changes to prescribing practices include:
No longer requiring the X-Waiver to treat patients with buprenorphine for opioid use disorder.
Removing any limits or caps on the number of patients a prescriber may treat with buprenorphine for opioid use disorder.
Only requiring a standard Drug Enforcement Administration registration number for all prescriptions for buprenorphine moving forward.
Maintaining existing state laws or regulations that may be applicable.
Introducing new training requirements for all prescribers that are expected to take effect June 21, 2023. These requirements have not yet been made clear, but do not impact the elimination of the X-Waiver.
Biden held an event at the White House Jan. 24 celebrating the policy change as a bipartisan success that will increase access to medication for opioid use disorder. The additional barriers the X-Waiver presented deterred providers from offering these services and a similar license was never required for prescribing other controlled substances like opioids.
Current laws and regulations in Michigan have not changed because of the changes to federal X-Waiver requirements, but the Michigan Department of Licensing and Regulatory Affairs (LARA) is in the process of revising substance use disorder (SUD) rules that would no longer require a SUD program license for buprenorphine providers. The Michigan Public Health code currently states:
A substance use disorder services program license is required if a prescriber is providing buprenorphine treatment to more than 100 individuals OR is providing methadone treatment.
No license is needed if a prescriber is administering buprenorphine treatment to less than 100 individuals at a time.
To help raise awareness around Emergency Department (ED) Medication for Opioid Use Disorder (MOUD), the MHA will host a Twitter chat from noon to 1 p.m. April 4. During the event, the MHA will post questions from @MIHospitalAssoc, with commentary from the MHA Keystone Center, the Community Foundation of Southeast Michigan (CFSEM) and other members of the Michigan Opioid Partnership. MHA-member hospitals and community organizations are encouraged to share their current initiatives and success stories using the hashtags #MHAHealthChat, #MOUD, and #MAT.
The event follows an announcement of an ED MOUD initiative and funding opportunity for Michigan hospitals launched by the CFSEM in partnership with the MHA Keystone Center, the Michigan Opioid Partnership and the Michigan Department of Health and Human Services. The initiative aims to increase access to evidence-based medication for opioid use disorder and support the transition to long-term, office-based treatment upon discharge. Applications are now being accepted on a rolling basis until April 22. For the most current information, application instructions and grant guidelines, visit the CFSEM website, or contact the MHA Keystone Center to learn more.
Those with Twitter accounts are encouraged to participate in the chat to maximize the spread of information around ED MOUD, as many of these programs help address stigma and increase access to effective treatment for opioid use disorder. Those interested can confirm participation in the chat by contacting Lucy Ciaramitaro at the MHA.
The MHA Keystone Center is working alongside the Community Foundation for Southeast Michigan (CFSEM) through the Michigan Opioid Partnership to provide funding and technical assistance for the emergency department-based medication for opioid use disorder (ED MOUD) program. The program will increase access to medication for OUD statewide and connect patients receiving MOUD with appropriate resources to continue care in the community. An online video provides additional information on the program.
The CFSEM recently released impact stories highlighting successes of the program from previous participants. Andrew King, MD, an emergency room physician at Detroit Medical Center and advisor to the CFSEM, has witnessed the effectiveness of MOUD and reminds practitioners that it is possible to guide those with OUD down a path to recovery.
“I can see the people who are now on medications and feeling much better and doing well. They are happy and putting their lives back together, and that’s a beautiful thing!” King says. “By controlling the disease process, maybe they’re treating their kids or their spouse better or they’re doing a better job at work. That’s the whole point of why we signed up for this job — trying to keep people safe and healthy and in the game for as long as possible.” An article from the CFSEM provides additional information.
The MHA has also been advocating to improve legislation related to ED MOUD by working with the Michigan Department of Health and Human Services to ensure all hospitals interested in starting an emergency department-based medication assisted treatment program have the funding resources to do so.