It is the position of the American Academy of Emergency Medicine that Emergency Physicians (EPs) offer to administer and prescribe buprenorphine for the management of opioid use disorder (OUD). As fatal opioid overdoses continue to be a public health crisis across the United States, we believe that EPs have a unique ability and responsibility to initiate evidence-based, lifesaving treatments for this disease, whenever indicated, from the emergency department (ED) setting.
AAEM firmly supports Section 1262 of the Consolidated Appropriations Act, 2023, which effectively eliminated the DATA-2000 Waiver (“X-Waiver”) requirement for buprenorphine prescribing1. These prior requirements severely restricted the prescribing of buprenorphine, and thus limited access to this lifesaving treatment for OUD. With the elimination of the DATA-2000 Waiver requirement, any provider with DEA schedule III privileges can now prescribe buprenorphine for OUD. As such, we view the passage of this legislation as an important step forward in improving access to effective, evidence-based care for patients with OUD, and in reducing its significant morbidity and mortality.
AAEM maintains that all EPs should be capable of not only diagnosing OUD, but also treating OUD by administering and/or prescribing buprenorphine. EPs frequently care for those who have experienced opioid overdose or other complications of OUD, and are often the primary healthcare access point for those with the most severe forms of OUD. Thus, EPs are optimally situated to improve outcomes for those at highest risk of overdose and mortality related to OUD2-4. EPs should be aware of local substance use disorder resources and refer patients with untreated OUD to outpatient Addiction Medicine care for continuation of treatment after ED discharge. As the opioid addiction and overdose epidemic is a continuing public health crisis, AAEM asserts that training on the diagnosis and treatment of OUD should be standard across all medical school and Emergency Medicine residency curricula.
- SAMHSA. Removal of DATA Waiver (X-Waiver) Requirement. Updated March 29, 2023. Accessed March 29, 2023. https://www.samhsa.gov/medications-substance-use-disorders/removal-data-waiver-requirement.
- Shastry S, Counts C, Shegog E, Loo G, Cowan E. Emergency Department Utilization Patterns in Patients with Opioid-Related Emergency Department Visits. Subst Use Misuse. 2022;57(6):995-998. doi:10.1080/10826084.2022.2046098
- Leece P, Chen C, Manson H, et al. One-Year Mortality After Emergency Department Visit for Nonfatal Opioid Poisoning: A Population-Based Analysis. Ann Emerg Med. Jan 2020;75(1):20-28. doi:10.1016/j.annemergmed.2019.07.021
- Moe J, Camargo CA, Davis RB, Jelinski S, Rowe BH. Frequent emergency department use and mortality in patients with substance and opioid use in Alberta: A population-based retrospective cohort study. Cjem. Jul 2019;21(4):482-491. doi:10.1017/cem.2019.15