Impact of X-Waiver Elimination on Post-Hospital Discharge Buprenorphine Prescribing: An Interrupted Time Series Analysis.

OBJECTIVES

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).

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.