Description of Buprenorphine-Involved Opioid Overdose Deaths Prior to and After the X-Waiver Elimination in Illinois

In December 2022 as opioid overdose deaths (OODs) were claiming over 80,000 lives annually, the federal government eliminated the drug enforcement agency’s X-waiver requirement in attempt to expand access to buprenorphine, a lifesaving medication for opioid use disorder. While buprenorphine is thought to be protective against OODs, it has been found in postmortem OOD analyses. Previous studies have found buprenorphine involvement in 2-3% of OODs. The effect of eliminating the X-waiver on buprenorphine involvement in OODs has not been studied. The objective of this study is to describe buprenorphine involvement in OODs in Illinois and describe any effect that elimination of the X-waiver had on buprenorphine involvement in OODs.

Data came from the Illinois Statewide Unintentional Drug Overdose Reporting System (IL SUDORS), a database of unintentional overdose fatalities spanning 2019 to 2024. Buprenorphine involvement was determined using toxicology reports. Demographics were reported using descriptive statistics. A multivariate logistic regression model was used to describe associations with buprenorphine involvement in OODs. An interrupted time series was conducted using a modified Poisson regression with robust standard errors to assess trends in buprenorphine involvement in OODs before and after the elimination of the X-waiver.

Of the 17,757 overdose deaths in the IL SUDORS database from 2019 to 2024, 85% (15,096) were attributed to opioids. The median age of these OODs was 45 years old, 74% (11,223) were male and 74% were white (5,815). The annual proportion of OODs involving buprenorphine ranged from 1.8% (46/2634) in 2020 to 2.7% (49/1849) in 2024. After adjusting for demographics and time, buprenorphine involvement in OODs associated with white race, recent hospitalization, and substance use disorder treatment, but not recent ED visits. The interrupted time series analysis showed no significant pre-intervention trend, no immediate level change in December 2022, and no significant change in the post-intervention trend in the rate of buprenorphine involvement.

The overall involvement of buprenorphine in IL OODs from 2019 to 2024 was low. The elimination of the X-waiver did not have an effect on buprenorphine involvement in OODs in Illinois. Future research should focus on examining whether or not buprenorphine is protective against OODs.