January 13, 2023

X-Waiver No Longer Required to Treat Opioid Use Disorder

The X-waiver requirement is officially rescinded!

On January 12, 2023, the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Drug Enforcement Administration (DEA) issued guidance on the removal of the X-waiver — an ACEP priority that was included in the Consolidated Appropriations Act, 2023.

ACEP has advocated for years for Congress to repeal the X-waiver requirement, which was a significant barrier to the treatment of opioid use disorder and contributed to stigma around the disease. As mentioned in a recent regulatory blog post, ACEP reached out to SAMSHA and the DEA immediately upon the passage of the legislation to request that they issue guidance effectuating the policy change as soon as possible.

As stated in the guidance, an X-waiver is no longer required to treat patients with buprenorphine for opioid use disorder. Going forward, all prescriptions for buprenorphine will only require a standard DEA registration number. There are no longer any limits or patient caps on the number of patients a prescriber may treat for opioid use disorder with buprenorphine. Existing state laws or regulations still apply.

SAMHSA also will no longer be accepting new waiver applications.

Separately, the Consolidated Appropriations Act, 2023 also introduced new training requirements for all prescribers. These requirements will not go into effect until June 21, 2023. The DEA and SAMHSA are actively working to provide further guidance and DEA will follow up with additional information on these requirements shortly.

In all, now all physicians and other health care professionals with a regular DEA license can prescribe buprenorphine. ACEP has clinical tools and training courses to help provide you with best practices and the most up-to-date evidence-based protocols regarding this treatment. We can also help answer any questions you have about this significant change in policy.


January 12, 2023

Point of Care Tool: Buprenorphine Use

January 12, 2023

Consensus Recommendations on the Treatment of Opioid Use Disorder in the ED

January 12, 2023

Get Answers from ACEP’s EM Opioid Advisory Network

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