Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora.
Department of General Internal Medicine, Denver Health and Hospital Authority, Denver, Colorado.
JAMA Netw Open. 2024 Aug 1;7(8):e2425999. doi: 10.1001/jamanetworkopen.2024.25999.
Local-level data are needed to understand whether the relaxation of X-waiver training requirements for prescribing buprenorphine in April 2021 translated to increased buprenorphine treatment.
To assess whether relaxation of X-waiver training requirements was associated with changes in the number of clinicians waivered to and who prescribe buprenorphine for opioid use disorder and the number of patients receiving treatment.
DESIGN, SETTING, AND PARTICIPANTS: This serial cross-sectional study uses an interrupted time series analysis of 2020-2022 data from the HEALing Communities Study (HCS), a cluster-randomized, wait-list-controlled trial. Urban and rural communities in 4 states (Kentucky, Massachusetts, New York, and Ohio) with a high burden of opioid overdoses that had not yet received the HCS intervention were included.
Relaxation of X-waiver training requirements (ie, allowing training-exempt X-waivers) on April 28, 2021.
The monthly number of X-waivered clinicians, X-waivered buprenorphine prescribers, and patients receiving buprenorphine were each summed across communities within a state. Segmented linear regression models to estimate pre- and post-policy change by state were used.
The number of individuals in 33 participating HCS communities included 347 863 in Massachusetts, 815 794 in Kentucky, 971 490 in New York, and 1 623 958 in Ohio. The distribution of age (18-35 years: range, 29.4%-32.4%; 35-54 years: range, 29.9%-32.5%; ≥55 years: range, 35.7%-39.3%) and sex (female: range, 51.1%-52.6%) was similar across communities. There was a temporal increase in the number of X-waivered clinicians in the pre-policy change period in all states, which further increased in the post-policy change period in each state except Ohio, ranging from 5.2% (95% CI, 3.1%-7.3%) in Massachusetts communities to 8.4% (95% CI, 6.5%-10.3%) in Kentucky communities. Only communities in Kentucky showed an increase in the number of X-waivered clinicians prescribing buprenorphine associated with the policy change (relative increase, 3.2%; 95% CI, 1.5%-4.9%), while communities in other states showed no change or a decrease. Similarly, only communities in Massachusetts experienced an increase in patients receiving buprenorphine associated with the policy change (relative increase, 1.7%; 95% CI, 0.8%-2.6%), while communities in other states showed no change.
In this serial cross-sectional study, relaxation of X-waiver training requirements was associated with an increase in the number of X-waivered clinicians but was not consistently associated with an increase in the number of buprenorphine prescribers or patients receiving buprenorphine. These findings suggest that training requirements may not be the primary barrier to expanding buprenorphine treatment.
需要地方层面的数据来了解 2021 年 4 月放宽丁丙诺啡处方 X 豁免培训要求是否转化为增加丁丙诺啡治疗。
评估放宽 X 豁免培训要求是否与增加获得丁丙诺啡治疗的阿片类药物使用障碍的豁免和开处丁丙诺啡的临床医生数量以及接受治疗的患者数量有关。
设计、设置和参与者：本研究采用 2020-2022 年 HEALing 社区研究（HCS）的一项中断时间序列分析，这是一项集群随机、等待名单对照试验。研究纳入了 4 个州（肯塔基州、马萨诸塞州、纽约州和俄亥俄州）的城市和农村社区，这些社区的阿片类药物过量负担很高，但尚未接受 HCS 干预。
2021 年 4 月 28 日放宽 X 豁免培训要求（即允许豁免 X 豁免培训的培训）。
在每个州内，通过社区汇总 X 豁免临床医生、X 豁免丁丙诺啡处方者和接受丁丙诺啡治疗的患者的每月数量。使用分段线性回归模型估计政策变化前后的州级数据。
33 个参与 HCS 社区的个体数量包括马萨诸塞州的 347863 人、肯塔基州的 815794 人、纽约州的 971490 人和俄亥俄州的 1623958 人。各社区年龄（18-35 岁：范围，29.4%-32.4%；35-54 岁：范围，29.9%-32.5%；≥55 岁：范围，35.7%-39.3%）和性别（女性：范围，51.1%-52.6%）分布相似。在所有州，政策变化前的豁免临床医生人数呈时间增加趋势，除俄亥俄州外，各州在政策变化后进一步增加，范围从马萨诸塞州社区的 5.2%（95%CI，3.1%-7.3%）到肯塔基州社区的 8.4%（95%CI，6.5%-10.3%）。只有肯塔基州的社区显示出与政策变化相关的 X 豁免临床医生开处丁丙诺啡数量的增加（相对增加，3.2%；95%CI，1.5%-4.9%），而其他州的社区没有变化或减少。同样，只有马萨诸塞州的社区显示出与政策变化相关的接受丁丙诺啡治疗的患者数量增加（相对增加，1.7%；95%CI，0.8%-2.6%），而其他州的社区没有变化。
在这项横断面研究中，放宽 X 豁免培训要求与 X 豁免临床医生人数的增加有关，但与丁丙诺啡处方者人数或接受丁丙诺啡治疗的患者人数的增加无关。这些发现表明，培训要求可能不是扩大丁丙诺啡治疗的主要障碍。
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