Wang Philip R, Mascha Edward J, Li Yufei, Bobak Lukas, Dorney Ian, Costa Gabriel, Barnett Brian, Anand Akhil
J Addict Med. 2025 Aug 11. doi: 10.1097/ADM.0000000000001568.
This study aimed to assess the impact of the X-waiver elimination on buprenorphine prescribing following hospital discharge in patients with opioid use disorder (OUD).
We conducted a retrospective cohort study using TriNetX, an aggregated electronic health record (EHR) research network containing the de-identified EHR data from over 60 million patients. Hospitalized adult patients with OUD were identified using diagnostic and discharge procedure codes between January 2022 and June 2023, spanning 1 year before and 6 months after waiver elimination. The primary outcome was the proportion of patients receiving a buprenorphine prescription within 1 month of discharge. We used an interrupted time series design with segmented logistic regression to examine changes in the prescription rate over time while adjusting for patient demographics and medical comorbidities.
Among 64,979 hospitalizations, 45,288 occurred before and 19,691 after the X-waiver elimination. Overall, 14.3% of patients received a postdischarge buprenorphine prescription. Unadjusted analysis revealed an initial increase in prescriptions at the start of the postelimination period [odds ratio (OR): 1.2, 95% CI: 1.1-1.3, P < 0.001]. However, after adjusting for potential confounding due to baseline imbalances, both the immediate change in the proportion with prescriptions [OR: 1.12 (0.97, 1.3), P = 0.11] and slope [difference (SE) of -0.0074 (0.0057), P = 0.20] between the periods were not statistically significant.
The elimination of the X-waiver does not appear to have altered buprenorphine prescribing practices in the short term, which suggests that long-term studies and additional strategies may be needed to address persistent barriers to effective treatment for OUD.
本研究旨在评估取消X豁免对阿片类物质使用障碍（OUD）患者出院后丁丙诺啡处方开具的影响。
我们使用TriNetX进行了一项回顾性队列研究，TriNetX是一个汇总电子健康记录（EHR）研究网络，包含来自超过6000万患者的去识别化EHR数据。使用2022年1月至2023年6月期间的诊断和出院程序代码识别住院的成年OUD患者，涵盖豁免取消前1年和取消后6个月。主要结局是出院后1个月内接受丁丙诺啡处方的患者比例。我们采用中断时间序列设计和分段逻辑回归来检查处方率随时间的变化，同时调整患者人口统计学和医疗合并症。
在64979次住院中，45288次发生在X豁免取消之前，19691次发生在之后。总体而言，14.3%的患者出院后接受了丁丙诺啡处方。未调整分析显示，取消豁免后初期处方量有所增加[优势比（OR）：1.2，95%置信区间（CI）：1.1 - 1.3，P < 0.001]。然而，在调整因基线不平衡导致的潜在混杂因素后，两个时期之间处方比例的即时变化[OR：1.12（0.97，1.3），P = 0.11]和斜率[差异（SE）为 - 0.0074（0.0057），P = 0.20]均无统计学意义。
取消X豁免似乎在短期内未改变丁丙诺啡的处方开具行为，这表明可能需要进行长期研究并采取其他策略来解决OUD有效治疗的持续障碍。
