Medicaid Expansion and Availability of Opioid Medications in the Specialty Substance Use Disorder Treatment System.
Medicaid Expansion and Availability of Opioid Medications in the Specialty Substance Use Disorder Treatment System.
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DOI：
10.1176/appi.ps.202000049
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发表时间：
2021-02-01
期刊：
影响因子：
--
通讯作者：
Andrews CM
中科院分区：
文献类型：
--
作者：
Abraham AJ;Yarbrough CR;Harris SJ;Adams GB;Andrews CM
研究检查了医疗补助扩大对获得丁丙诺啡豁免的医生的影响，但较少关注医疗补助对专业物质使用障碍治疗系统中阿片类药物使用障碍药物可用性的影响。为了解决文献中的这一差距，本研究探讨了医疗补助扩大对专业项目中阿片类药物可用性的影响。这项研究使用的数据来自全国药物滥用治疗服务调查（2002-2017），包含美国所有已知的物质使用障碍治疗项目，以按治疗项目所有权类型检查医疗补助扩展对阿片类药物使用障碍药物可用性的影响（公有，私营营利和私营非营利）阿片类药物治疗计划（OTP）和非OTP。医疗补助扩张的影响仅限于非营利性和营利性OTP。医疗补助的扩大分别与提供注射用纳洛酮的非营利性和营利性OTP数量增加135.1%和57.5%相关，并且与提供丁丙诺啡的非营利性OTP数量增加64.4%相关。非营利性和营利性OTP占治疗系统的<10%，这表明与医疗补助扩张相关的阿片类药物使用障碍治疗的改善仅限于专业系统的一小部分。医疗补助扩展对专科治疗系统的影响有限，可能会使医疗补助注册者的阿片类药物使用障碍治疗的可及性和质量长期存在差异，并且无法缓解这一弱势群体中阿片类药物使用障碍和阿片类药物过量死亡的高发生率。
Research has examined the effect of Medicaid expansion on access to physicians with buprenorphine waivers, but less attention has been paid to Medicaid’s impact on opioid use disorder medication availability within the specialty substance use disorder treatment system. To address this gap in the literature, this study examined the impact of Medicaid expansion on availability of opioid medications in specialty programs. This study used data from the National Survey of the Substance Abuse Treatment Services (2002–2017), containing all known substance use disorder treatment programs in the United States, to examine the effect of Medicaid expansion on the availability of opioid use disorder medications by treatment program ownership type (publicly owned, private for profit, and private nonprofit) among opioid treatment programs (OTPs) and non-OTPs. The effects of Medicaid expansion were limited to nonprofit and for-profit OTPs. Medicaid expansion was associated with 135.1% and 57.5% increases in the number of nonprofit and for-profit OTPs offering injectable naltrexone, respectively, and with a 64.4% increase in the number of nonprofit OTPs offering buprenorphine. Nonprofit and for-profit OTPs compose <10% of the treatment system, indicating that improvements in opioid use disorder treatment associated with Medicaid expansion were limited to a small share of the specialty system. The limited impact of Medicaid expansion on the specialty treatment system may perpetuate disparities in the accessibility and quality of opioid use disorder treatment for Medicaid enrollees and fail to alleviate high rates of opioid use disorder and opioid overdose deaths in this vulnerable population.
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影响因子：
3.4
作者：
Heinrich, Carolyn J.;Cummings, Grant R.
通讯作者：
Cummings, Grant R.
影响因子：
9.7
作者：
Olfson, Mark;Wall, Melanie;Mojtabai, Ramin
通讯作者：
Mojtabai, Ramin
DOI：
10.1176/appi.ps.201100034
发表时间：
2012-01
期刊：
Psychiatric services (Washington, D.C.)
影响因子：
--
作者：
Knudsen HK;Abraham AJ
通讯作者：
Abraham AJ
影响因子：
3.5
作者：
Meinhofer, Angelica;Witman, Allison E.
通讯作者：
Witman, Allison E.
影响因子：
3.9
作者：
Knudsen, Hannah K.;Oser, Carrie B.;Roman, Paul M.
通讯作者：
Roman, Paul M.