Differences in Availability and Use of Medications for Opioid Use Disorder in Residential Treatment Settings in the United States.
Differences in Availability and Use of Medications for Opioid Use Disorder in Residential Treatment Settings in the United States.
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DOI：
10.1001/jamanetworkopen.2019.20843
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发表时间：
2020-02-05
影响因子：
13.8
通讯作者：
Dunn KE
中科院分区：
文献类型：
--
作者：
Huhn AS;Hobelmann JG;Strickland JC;Oyler GA;Bergeria CL;Umbricht A;Dunn KE
美国正处于一场致命且旷日持久的阿片类药物危机之中。虽然许多患有阿片类药物使用障碍 (OUD) 的人在住宿设施中寻求治疗以开始长期康复，但这些设施中 OUD (MOUD) 药物的可用性和使用情况尚不清楚。检查住宅设施中 MOUD 可用性和利用率的差异作为医疗补助政策的函数，以及分别与 MOUD 可用性和利用率相关的设施级别和治疗入院级别因素。对 2017 年美国各地住院治疗机构的去识别化机构级别和入院级别数据进行观察性横断面研究。统计分析于 2019 年进行。住院机构向药物滥用和心理健康服务管理局报告。设施级数据从 2017 年全国药物滥用治疗服务调查 (NSSATS) 中提取，住宿设施的入院级数据从 2017 年治疗事件数据集入院 (TEDS-A) 中提取。 OUD 入院将阿片类药物确定为美国住院治疗机构的主要选择药物。 MOUD 可用性定义为在特定的住院治疗机构提供缓释纳曲酮 (XR-NTX)、丁丙诺啡和/或美沙酮。 MOUD 利用率被定义为住院治疗期间任何 MOUD 的计划使用。提供缓释纳曲酮 (XR-NTX) (29.8%)、丁丙诺啡 (33.3%) 或美沙酮 (2.1%) 的住宅治疗机构比例相对较低 (n=2,863)。关于住院治疗入院（n=232,414），在扩大医疗补助或未扩大医疗补助的州，MOUD 分别仅在 17.3% 和 1.9% 的入院中使用（p<0.001）。不提供 MOUD 的住宿机构比提供 ≥1 MOUD 的机构同时提供精神科药物的几率更低（比值比 [OR]=0.06，95% 置信区间 [CI]=0.05–0.08，p<0.001），并获得州/医院当局许可（OR=0.39，95% CI=0.27–0.57，p<0.001），或获得卫生组织认可（OR=0.28，95% CI=0.23–0.33，p<0.001），并且接受纯现金支付的几率较高（OR=4.80，95% CI=3.47–6.64，p<0.001）。在这项针对美国住宅成瘾治疗设施的横断面研究中，MOUD 的可用性和利用率很少。改善住院治疗设施中 MOUD 的获取和利用的公共卫生和政策努力可以改善开始康复者的治疗结果。
The U.S. is in the midst of a deadly and protracted opioid crisis. While many individuals with opioid use disorder (OUD) seek treatment at residential facilities to initiate long-term recovery, the availability and utilization of medications for OUD (MOUD) in these facilities is unclear. Examine differences in MOUD availability and utilization in residential facilities as a function of Medicaid policy, as well as facility-level and treatment admissions-level factors associated with MOUD availability and utilization, respectively. Observational, cross-sectional study of deidentified facility-level and admissions-level data from residential treatment facilities across the U.S. in 2017. Statistical analyses occurred in 2019. Residential facilities reporting to the Substance Abuse and Mental Health Services Administration. Facility-level data were extracted from the 2017 National Survey of Substance Abuse Treatment Services (NSSATS), and admissions-level data from residential facilities were extracted from the 2017 Treatment Episode Data Set-Admissions (TEDS-A). OUD admissions that identified opioids as their primary drug of choice at residential treatment facilities in the U.S. MOUD availability was defined as offering extended-release naltrexone (XR-NTX), buprenorphine, and/or methadone at a given residential facility. MOUD utilization was defined as the planned use of any MOUD during residential treatment. A relatively low percentage of residential treatment facilities (n=2,863) offered extended-release naltrexone (XR-NTX) (29.8%), buprenorphine (33.3%), or methadone (2.1%). Regarding residential treatment admissions (n=232,414), MOUD was utilized in only 17.3% and 1.9% of admissions in states that did or did not expand Medicaid, respectively (p<0.001). Residential facilities that offered no MOUD had lower odds than facilities that offered ≥1 MOUD of also offering psychiatric medications (odds ratio [OR]=0.06, 95% confidence intervals [CI]=0.05–0.08, p<0.001), being licensed by a state/hospital authority (OR=0.39, 95% CI=0.27–0.57, p<0.001), or accredited by a health organization (OR=0.28, 95% CI=0.23–0.33, p<0.001), and had higher odds of accepting cash-only payments (OR=4.80, 95% CI=3.47–6.64, p<0.001). In this cross-sectional study of residential addiction treatment facilities in the U.S., MOUD availability and utilization was sparse. Public health and policy efforts to improve access to and utilization of MOUD in residential treatment facilities could improve treatment outcomes for persons initiating recovery.
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影响因子：
120.7
作者：
Chandler, Redonna K.;Fletcher, Bennett W.;Volkow, Nora D.
通讯作者：
Volkow, Nora D.
影响因子：
9.7
作者：
Clark, Robin E.;Samnaliev, Mihail;Leung, Gary Y.
通讯作者：
Leung, Gary Y.
影响因子：
9.7
作者：
Grogan, Colleen M.;Andrews, Christina;Friedmann, Peter D.
通讯作者：
Friedmann, Peter D.
DOI：
10.3109/10826088409057189
发表时间：
1984-01-01
期刊：
INTERNATIONAL JOURNAL OF THE ADDICTIONS
影响因子：
--
作者：
AIKEN, LS;LOSCIUTO, LA;BROWN, BS
通讯作者：
BROWN, BS
影响因子：
3.8
作者：
Brunette, MF;Mueser, KT;Drake, RE
通讯作者：
Drake, RE