ACMT Position Statement: Remove the Waiver Requirement for Prescribing Buprenorphine for Opioid Use Disorder

  • Ryan MarinoEmail author
  • Jeanmarie Perrone
  • Lewis S. Nelson
  • Timothy J. Wiegand
  • Evan S. Schwarz
  • Paul M. Wax
  • Andrew I. Stolbach
Position Statement

The position of the American College of Medical Toxicology (ACMT), endorsed by the American Academy of Clinical Toxicology, the American Academy of Emergency Medicine, and the American College of Emergency Physicians is as follows: To increase access for patients to receive treatment for opioid use disorder in the United States, we strongly recommend removing the waiver (“X-waiver”) requirement for buprenorphine prescribing.


Current US law requires prescribers to obtain a waiver (“X-waiver”) for outpatient prescription of buprenorphine [1]. The ongoing epidemic of opioid overdose deaths in North America represents a major public health crisis, with more than 48,000 Americans estimated to have died from opioid overdose in 2017 alone [2]. Opioid use disorder (OUD) is a chronic medical condition that can be treated with pharmacological therapies. In response to growing evidence, there is consensus within the healthcare community that opioid agonist therapy (OAT) is the best...


Buprenorphine Waiver X-waiver Opioid use disorder Opioid agonist therapy 


Sources of Funding


Compliance with Ethical Standards

Conflict of Interest



While individual practices may differ, this is the position of the American College of Medical Toxicology at the time written, after a review of the issue and pertinent literature.


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Copyright information

© American College of Medical Toxicology 2019

Authors and Affiliations

  • Ryan Marino
    • 1
    Email author
  • Jeanmarie Perrone
    • 2
  • Lewis S. Nelson
    • 3
  • Timothy J. Wiegand
    • 4
  • Evan S. Schwarz
    • 5
  • Paul M. Wax
    • 6
  • Andrew I. Stolbach
    • 7
  1. 1.Case Western Reserve University School of MedicineClevelandUSA
  2. 2.University of PennsylvaniaPhiladelphiaUSA
  3. 3.Rutgers New Jersey Medical SchoolNewarkUSA
  4. 4.University of Rochester Medical CenterRochesterUSA
  5. 5.Division of Emergency MedicineWashington University School of MedicineSt. LouisUSA
  6. 6.University of Texas SouthwesternDallasUSA
  7. 7.Johns Hopkins University School of MedicineBaltimoreUSA

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