{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T13:26:49Z","timestamp":1791725209691,"version":"4.3.4"},"reference-count":41,"publisher":"American Medical Association (AMA)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n 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\u2013controlled 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.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n Relaxation of X-waiver training requirements (ie, allowing training-exempt X-waivers) on April 28, 2021.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n 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\u2013 and post\u2013policy change by state were used.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The number of individuals in 33 participating HCS communities included 347\u202f863 in Massachusetts, 815\u202f794 in Kentucky, 971\u202f490 in New York, and 1\u202f623\u202f958 in Ohio. The distribution of age (18-35 years: range, 29.4%-32.4%; 35-54 years: range, 29.9%-32.5%; \u226555 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\u2013policy change period in all states, which further increased in the post\u2013policy 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.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.25999","type":"journal-article","created":{"date-parts":[[2024,8,5]],"date-time":"2024-08-05T11:56:47Z","timestamp":1722859007000},"page":"e2425999","source":"Crossref","is-referenced-by-count":34,"title":["Buprenorphine Prescribing Characteristics Following Relaxation of X-Waiver Training Requirements"],"prefix":"10.1001","volume":"7","author":[{"given":"Paul J.","family":"Christine","sequence":"first","affiliation":[{"name":"Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora"},{"name":"Department of General Internal Medicine, Denver Health and Hospital Authority, Denver, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rouba A.","family":"Chahine","sequence":"additional","affiliation":[{"name":"Social, Statistical, and 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