This practice-oriented article explains the federal buprenorphine X-waiver training exemption announced in 2021 and reviews foundational prescribing issues for obstetric clinicians. It was written when eligible clinicians could seek an exemption from certain training requirements for treatment of up to 30 patients. The article offers historical context and clinical guidance, not original treatment-outcome data. Its regulatory discussion is historical: the federal X-waiver requirement was subsequently eliminated, so current prescribing rules must be checked separately.
Abstract
Buprenorphine is 1 of 3 medications approved by the US Food and Drug Administration for the treatment of opioid use disorder, and practitioners must obtain a federal waiver to prescribe buprenorphine. Until recently, physicians and advanced practice clinicians were required to complete 8 and 24 hours of training, respectively, before applying for this waiver and to provide psychosocial services when prescribing buprenorphine to ≤30 patients. The US Department of Health and Human Services announced in April 2021 that eligible providers would be exempt from the educational requirement for certification, making the waiver more accessible for those intending to prescribe to ≤30 patients. Here, we reviewed the historic background to the exemption and provided practical guidelines to practitioners caring for obstetrical patients with opioid use disorder who are considering applying for the waiver for the first time. Because the educational requirements will no longer be required for X-waiver application, we reviewed fundamental topics and challenging scenarios that are often reviewed in certification courses.
