Eliminate the buprenorphine DEA X waiver: Justification using a policy analysis approach.
Eliminate the buprenorphine DEA X waiver: Justification using a policy analysis approach.
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取消丁丙诺啡 DEA X 豁免：使用政策分析方法进行论证。
DOI：
10.1111/jnu.12871
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Tierney,Matthew
中科院分区：
文献类型：
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作者：
Jones,KatieFitzgerald;O'ReillyJacob,Monica;Spetz,Joanne;Hailer,Laurie;Tierney,Matthew
药物过量已达到一个历史性的里程碑，一年内死亡人数超过10万人，其中75,673人与阿片类药物有关。阿片类药物相关死亡的加速，加上严重的卫生不公平，要求密切审查阿片类药物使用障碍（OUD）的治疗障碍，并迅速考虑政策变化。设计本丁丙诺啡政策分析的目的是总结现有的丁丙诺啡障碍，并提出政策解决方案，以改善高级执业注册护士（APRNs）的获取和实现贡献。方法政策分析遵循五个连续步骤：(1)定义问题，(2)确定关键利益相关者，(3)评估相关政策的前景，(4)描述可行的政策方案，(5)提出最终建议。尽管改善丁丙诺啡获取的努力值得称赞，例如2021年4月发布的新的丁丙诺啡指南，但如果没有对联邦、州和实践范围的法律进行更大规模的修改，过量使用率将继续上升。我们建议采取多管齐下的政策方法来改善丁丙诺啡治疗的可及性，包括取消DEA X豁免，改善OUD教育，并在所有州对aprn采取全面的实践授权。结论渐进式改变不再足以解决阿片类药物过量死亡问题。更大胆、更协调的政策行动是可能的，也是必要的，以使所有临床工作人员能够对OUD应用基于证据的挽救生命的治疗。美国国家医学院的报告《护理的未来：绘制实现卫生公平之路》强调了护士在促进公平获得OUD护理方面的重要贡献。护士在改善丁丙诺啡获取方面发挥了重要作用。迫切需要改变政策，承认并以循证治疗扩大战略为基础。临床相关性对抗阿片类药物过量死亡的最有力工具之一是丁丙诺啡，一种部分阿片类药物激动剂，以及OUD的金标准药物治疗，但只有5%的处方人员拥有所需的缉毒局（DEA） X豁免。越来越多的证据表明，高级执业注册护士正在加速豁免更新和丁丙诺啡使用的增长，尽管在本政策分析中描述了相当大的障碍和限制。
IntroductionDrug overdoses have reached a historic milestone of over 100,000 deaths in a single year, 75,673 related to opioids. The acceleration in opioid‐related deaths coupled with stark health inequities demands a close examination of opioid use disorder (OUD) treatment barriers and swift consideration of policy changes.DesignThe aim of this buprenorphine policy analysis is to summarize existing buprenorphine barriers and present policy solutions to improve access and actualize the contributions of Advanced Practice Registered Nurses (APRNs).MethodsThe policy analysis follows five sequential steps: (1) defining the problem, (2) identifying key stakeholders, (3) assessing the landscape of relevant policies, (4) describing viable policy options, and (5) making final recommendations.ResultsAlthough there are laudable efforts to improve buprenorphine access, such as the new buprenorphine guidelines issued in April 2021, without larger‐scale changes to federal, state, and scope of practice laws, overdose rates will continue to rise. We recommend a multipronged policy approach to improve buprenorphine treatment access, including eliminating the DEA X waiver, improving OUD education, and adopting full practice authority for APRNs in all states.ConclusionIncremental change is no longer sufficient to address opioid overdose deaths. Bolder and coordinated policy action is possible and necessary to empower the full clinical workforce to apply evidence‐based life‐saving treatments for OUD. The critical contributions of nurses in advancing equitable access to OUD care are emphasized in the National Academy of Medicine's Report, Future of Nursing: Charting a Path to Achieve Health Equity. Nurses are named as instrumental in improving buprenorphine access. Policy changes that acknowledge and build on evidence‐based treatment expansion strategies are sorely needed.Clinical RelevanceOne of the most robust tools to combat opioid overdose deaths is buprenorphine, a partial opioid agonist, and gold standard medication treatment for OUD, but only 5% of the prescribing workforce possess the required Drug Enforcement Agency (DEA) X waiver. A growing body of evidence demonstrates that Advanced Practice Registered Nurses are accelerating the growth in waiver update and buprenorphine use, despite the considerable barriers and limitations described in this policy analysis.