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Historically, this process has required certified training, which could be a barrier to obtaining an x\u2010waiver and subsequently prescribing. To address this barrier, the US recently removed the training requirement for some clinicians. We sought to determine if clinicians who attended x\u2010waiver training went on to obtain an x\u2010waiver and prescribe B\u2010MOUD, and to examine what facilitated or impeded B\u2010MOUD prescribing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In September 2020, we conducted a cross\u2010sectional, electronic survey of attendees of 15 in\u2010person x\u2010waiver pieces of training from June 2018 to January 2020 within the Veterans Health Administration (VHA). Of the attendees (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009321), we surveyed current VHA clinicians who recalled taking the training. The survey assessed whether clinicians obtained the x\u2010waiver, had prescribed B\u2010MOUD, and barriers or facilitators that influenced B\u2010MOUD prescribing.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 251 eligible participants, 62 (24.7%) responded to the survey, including 27 (43.5%) physicians, 16 (25.8%) advanced practice clinicians, and 12 (19.4%) pharmacists. Of the 43 clinicians who could prescribe, 29 (67.4%) had obtained their x\u2010waiver and 16 (37.2%) had reported prescribing B\u2010MOUD. Prominent barriers to prescribing B\u2010MOUD included a lack of supporting clinical staff and competing demands on time. The primary facilitator to prescribing was leadership support.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion and Scientific Significance<\/jats:title>\n                    <jats:p>Nine months after x\u2010waiver training, two\u2010thirds of clinicians with prescribing credentials had obtained their x\u2010waiver and one\u2010third were prescribing B\u2010MOUD. Removing the x\u2010waiver training may not have the intended policy effect as other barriers to B\u2010MOUD prescribing persist.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ajad.13260","type":"journal-article","created":{"date-parts":[[2022,2,4]],"date-time":"2022-02-04T00:15:31Z","timestamp":1643933731000},"page":"152-158","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":31,"title":["Are x\u2010waiver trainings enough? Facilitators and barriers to buprenorphine prescribing after x\u2010waiver trainings"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2453-8871","authenticated-orcid":false,"given":"Adam J.","family":"Gordon","sequence":"first","affiliation":[{"name":"Informatics, Decision\u2010Enhancement, and Analytic Sciences (IDEAS) Center of Innovation VA Salt Lake City Health Care System Salt Lake City Utah USA"},{"name":"Vulnerable Veteran Innovative PACT (VIP) Initiative VA Salt Lake City Health Care System Salt Lake City Utah USA"},{"name":"Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), University of Utah School of Medicine, Department of Internal Medicine University of Utah School of Medicine Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6808-3146","authenticated-orcid":false,"given":"Marie","family":"Kenny","sequence":"additional","affiliation":[{"name":"Center for Care Delivery &amp; Outcomes Research Minneapolis VA Health Care System Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Dungan","sequence":"additional","affiliation":[{"name":"Informatics, Decision\u2010Enhancement, and Analytic Sciences (IDEAS) Center of Innovation VA Salt Lake City Health Care System Salt Lake City Utah USA"},{"name":"Vulnerable Veteran Innovative PACT (VIP) Initiative VA Salt Lake City Health Care System Salt Lake City Utah USA"},{"name":"Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), University of Utah School of Medicine, Department of Internal Medicine University of Utah School of Medicine Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6401-1230","authenticated-orcid":false,"given":"Allison M.","family":"Gustavson","sequence":"additional","affiliation":[{"name":"Center for Care Delivery &amp; Outcomes Research Minneapolis VA Health Care System Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0462-4737","authenticated-orcid":false,"given":"A. Taylor","family":"Kelley","sequence":"additional","affiliation":[{"name":"Informatics, Decision\u2010Enhancement, and Analytic Sciences (IDEAS) Center of Innovation VA Salt Lake City Health Care System Salt Lake City Utah USA"},{"name":"Vulnerable Veteran Innovative PACT (VIP) Initiative VA Salt Lake City Health Care System Salt Lake City Utah USA"},{"name":"Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), University of Utah School of Medicine, Department of Internal Medicine University of Utah School of Medicine Salt Lake City Utah USA"},{"name":"Division of General Internal Medicine University of Utah School of Medicine Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1533-7469","authenticated-orcid":false,"given":"Audrey L.","family":"Jones","sequence":"additional","affiliation":[{"name":"Informatics, Decision\u2010Enhancement, and Analytic Sciences (IDEAS) Center of Innovation VA Salt Lake City Health Care System Salt Lake City Utah USA"},{"name":"Vulnerable Veteran Innovative PACT (VIP) Initiative VA Salt Lake City Health Care System Salt Lake City Utah USA"},{"name":"Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), University of Utah School of Medicine, Department of Internal Medicine University of Utah School of Medicine Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5467-1553","authenticated-orcid":false,"given":"Eric","family":"Hawkins","sequence":"additional","affiliation":[{"name":"Center of Innovation for Veteran\u2010Centered and Value\u2010Driven Care Veterans Affairs (VA) Puget Sound Health Care System Seattle Washington USA"},{"name":"Center of Excellence in Substance Addiction Treatment and Education VA Puget Sound Health Care System Seattle Washington USA"},{"name":"Department of Psychiatry and Behavioral Sciences University of Washington School of Medicine Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3043-4331","authenticated-orcid":false,"given":"Joseph W.","family":"Frank","sequence":"additional","affiliation":[{"name":"Center of Innovation for Veteran\u2010Centered and Value\u2010Driven Care VA Eastern Colorado Health Care System Aurora Colorado USA"},{"name":"Department of Medicine University of Colorado School of Medicine Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0893-5268","authenticated-orcid":false,"given":"Anissa","family":"Danner","sequence":"additional","affiliation":[{"name":"Center of Innovation for Veteran\u2010Centered and Value\u2010Driven Care Veterans Affairs (VA) Puget Sound Health Care System Seattle Washington USA"},{"name":"Center of Excellence in Substance Addiction Treatment and Education VA Puget Sound Health Care System Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Liberto","sequence":"additional","affiliation":[{"name":"Veterans Health Administration's Office of Mental Health and Suicide Prevention Substance Use Disorders Washington District of Columbia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5118-7624","authenticated-orcid":false,"given":"Hildi","family":"Hagedorn","sequence":"additional","affiliation":[{"name":"Center for Care Delivery &amp; 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