Hospitalist Buprenorphine Prescribing Before and After X-Waiver Removal at an Academic Center

Background: Studies on prescribing buprenorphine before and after buprenorphine training and the elimination of the X-waiver among hospitalists are limited. Objective: This study aims to determine hospitalists’ medication for opioid use disorder (MOUD) knowledge and beliefs before buprenorphine training and to assess MOUD prescribing patterns captured in the electronic medical record (EMR) pre-buprenorphine training, after training, and after elimination of the X-waiver. Design: Quantitative cohort survey study and quantitative retrospective medical record review. Participants: Hospitalists without an X-waiver before August 2022 (n = 70) at an academic hospital with a dedicated addiction consult service. Main Measures: For the survey, average composite scores of knowledge (higher score = more knowledge); for the EMR, MOUD inpatient, at discharge and ordering clinician specialty. Key Results: Fifty-four of 70 invited physicians (77.14%) completed the pre-training survey. The majority of participants provided counseling on MOUD (72.22%) before training, but only 46.3% initiated buprenorphine-naloxone, and 29.6% initiated methadone on patients with opioid use disorder (OUD) who were MOUD-naïve. The odds of a patient receiving an MOUD prescription at discharge post-training were higher than pre-training (OR = 1.69, [1.04, 2.70], p = 0.03). Having participated in the buprenorphine training was associated with greatly increased odds of prescribing buprenorphine at discharge (OR = 91.85, [28.17, 299.47], p < 0.001). The proportion of inpatient encounters with MOUD on their pre-hospitalization outpatient medication list that did not experience disruption of their MOUD during hospitalization increased over the three periods (82.05 to 83.64 to 93.33%; p < 0.001). Conclusions: Among a hospitalist group with high baseline MOUD knowledge, targeted buprenorphine training was associated with greater odds of prescribing buprenorphine. Fewer disruptions of the MOUD care continuum were observed over time which may reflect a combined impact of providing targeted education, changing federal policy change and having a dedicated addiction consult service.