Comparing Canadian and United States opioid agonist therapy policies
Comparing Canadian and United States opioid agonist therapy policies
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DOI：
10.1016/j.drugpo.2019.01.020
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发表时间：
2019-12-01
影响因子：
4.4
通讯作者：
McCarty, Dennis
中科院分区：
文献类型：
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作者：
Priest, Kelsey C.;Gorfinkel, Lauren;McCarty, Dennis
加拿大和美国面临阿片类药物使用障碍 (OUD) 和阿片类药物过量流行。最有效的 OUD 治疗是阿片类激动剂疗法 (OAT)、丁丙诺啡（含或不含纳洛酮）和美沙酮。尽管联邦早在几十年前就批准了 OAT，但在这两个国家，OAT 的获取和使用率都很低。限制性政策和复杂的法规限制了 OAT 的获取。通过非系统性的文献扫描和对公开政策文件的审查，我们检查并比较了联邦（加拿大与美国）和地方层面（不列颠哥伦比亚省与俄勒冈州）的 OAT 政策和实践。联邦和地方 OAT 政策以及随后的 OAT 获取之间存在差异和相似之处。在加拿大，OAT 政策控制已从联邦当局转移到省当局。相反，在美国，联邦当局对 OAT 法规保持主要控制权。 BC省和BC省当地的OAT健康保险覆盖政策有很大不同。和俄勒冈州。在 BC 省，有 5 种 OAT 选项可供选择，而在俄勒冈州，只有 2 种 OAT 选项可用，但存在行政限制。 BC 省之间本地 OAT 接入和覆盖政策的差异和俄勒冈州，部分原因可能是加拿大和美国联邦 OAT 政策的差异，特别是加拿大放松了特殊的联邦 OAT 监管控制。该分析还强调了其他药物政策子领域（例如处方制度和药物管制制度）和更广泛的政策领域（例如宪法权利）中存在的复杂贡献和可能的政策解决方案。美国政策制定者和卫生官员可以考虑采用加拿大的监管政策方法来扩大 OAT 的获取，以减轻持续的阿片类药物过量流行的危害。
Canada and the United States (U.S.) face an opioid use disorder (OUD) and opioid overdose epidemic. The most effective OUD treatment is opioid agonist therapy (OAT) buprenorphine (with and without naloxone) and methadone. Although federal approval for OAT occurred decades ago, in both countries, access to and use of OAT is low. Restrictive policies and complex regulations contribute to limited OAT access. Through a non-systematic literature scan and a review of publicly available policy documents, we examined and compared OAT policies and practice at the federal (Canada vs. U.S.) and local levels (British Columbia [B.C.] vs. Oregon). Differences and similarities were noted between federal and local OAT policies, and subsequently OAT access. In Canada, OAT policy control has shifted from federal to provincial authorities. Conversely, in the U.S., federal authorities maintain primary control of OAT regulations. Local OAT health insurance coverage policies were substantively different between B.C. and Oregon. In B.C., five OAT options were available, while in Oregon, only two OAT options were available with administrative limitations. The differences in local OAT access and coverage policies between B.C. and Oregon, may be explained, in part, to the differences in Canadian and U.S. federal OAT policies, specifically, the relaxation of special federal OAT regulatory controls in Canada. The analysis also highlights the complicating contributions, and likely policy solutions, that exist within other drug policy sub-domains (e.g., the prescription regime, and drug control regime) and broader policy domains (e.g., constitutional rights). U.S. policymakers and health officials could consider adopting Canada's regulatory policy approach to expand OAT access to mitigate the harms of the ongoing opioid overdose epidemic.