Meeting the Moment: More Infectious Disease Physicians Must Be Prepared to Provide Buprenorphine

(See the Major Article by Fujita AW, Loughry N, Moore DE, et al. “Prevalence, Distribution, and Characteristics Associated with Possession of Buprenorphine Waivers among Infectious Diseases Physicians in the United States”, https://doi.org/10.1093/cid/ciac909.) Injection-associated infections, including human immunodeficiency virus (HIV), hepatitis C virus, and invasive bacterial and fungal infections, such as endocarditis, have surged alongside the opioid overdose epidemic [1]. Opioid agonist medications, including methadone and buprenorphine, are life-saving treatments for opioid use disorder (OUD) that reduce fatal overdose and all-cause mortality, improve retention in care, and reduce infectious complications of injection drug use [2]. They are also associated with improved outcomes for the conditions that infectious disease (ID) physicians commonly treat among individuals with OUD, including HIV, hepatitis C, and invasive bacterial and fungal infections [3]. Fortunately, in addition to addiction treatment specialty settings (eg, opioid treatment programs), buprenorphine can be provided through office- and hospital-based settings to reach individuals with OUD. Notably, on 29 December 2022, President Biden signed the Consolidated Appropriations Act, 2023, including the Mainstreaming Addiction Treatment (MAT) Act, which eliminates the “X” waiver requirement to prescribe buprenorphine [4]. Prior to passage of the MAT Act, the Drug Addiction Treatment Act of 2000 (DATA 2000) and the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act of 2018 (SUPPORT Act) allowed qualified practitioners, such as physicians, nurse practitioners, physician assistants, and clinical nurse specialists, to provide buprenorphine upon obtaining a buprenorphine X waiver [5, 6]. Notably, as of April 2021, practitioners could treat up to 30 patients with OUD using buprenorphine without any additional specific trainings [6]. Passage of the MAT Act is a significant step to expand access to a life-saving medication for patients with OUD and we applaud Congress's support. However, future efforts will need to focus on expanding clinician capacity and comfort prescribing buprenorphine to ensure that patients benefit from this new legislation.