At long last, the “X-waiver” is finally eliminated

Taylor Nichols, MD
3 min readMar 21, 2023

The federal omnibus appropriations package that was signed into law by President Biden in January 2023 included language originally from the Mainstreaming Addiction Treatment (MAT) Act, which eliminated the requirement that healthcare providers possess a Drug Enforcement Administration (DEA) DATA 2000 waiver, or “X-waiver,” to prescribe buprenorphine to treat opioid use disorder (OUD). This should dramatically expand access to addiction treatment and in particular to buprenorphine.

Named after the DATA 2000 legislation which created this failed policy, and nicknamed X-waiver for the “X” that accompanies a narcotics prescribing license once prescribers have completed the adequate training, DEA X-waivers have been required to prescribe buprenorphine, a Schedule III drug, as treatment for OUD. Physicians applying for a waiver were required to complete 8 additional hours of training, while Nurse Practitioners (NPs) or Physicians Assistants (PAs) were required to complete an additional 24 hours of training specifically regarding to and be able to prescribe the medication buprenorphine for the treatment of OUD.

Additionally, prescribers who had obtained a waiver subsequently were limited in regards to the number of patients to whom they could prescribe buprenorphine at any one time. The starting number of potential active prescriptions for buprenorphine once an X-waiver was obtained was 30 patients. A prescriber could increase that number to 100 active prescriptions at any one time by applying to the DEA for an extension. Only once that prescriber had been at the 100 patient level for at least one year, the prescriber could then apply for another extension to a maximum of 275 patients. This created a significant barrier to treatment with a life changing and potentially life saving medication.

Given this barrier, I have long advocated for the removal of the X-waiver. Back in early 2019, I circulated a petition on Twitter which made the rounds of #MedTwitter, gained numerous contributors to write a letter to submitted to…

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Taylor Nichols, MD

Humanist. Emergency Medicine and AddictiEmergency + Addiction Medicine | Health policy and advocacy | Health tech and innovation