Buprenorphine implementation at syringe service programs following waiver of the Ryan Haight Act in the United States
Buprenorphine implementation at syringe service programs following waiver of the Ryan Haight Act in the United States
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DOI：
10.1016/j.drugalcdep.2022.109504
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发表时间：
2022-06-07
影响因子：
4.2
通讯作者：
Kral, Alex H.
中科院分区：
文献类型：
--
作者：
Lambdin, Barrot H.;Bluthenthal, Ricky N.;Kral, Alex H.
在美国，阿片类药物使用障碍患者中，只有10%接受丁丙诺啡治疗。瑞安海特法案是一项规范丁丙诺啡输送的联邦法律，要求在开始治疗前患者和提供者之间进行面对面检查。在COVID-19大流行开始时，联邦机构免除了丁丙诺啡治疗开始时的当面检查要求。我们研究了瑞安海特法案豁免是否改善了远程医疗丁丙诺啡在注射器服务计划（SSP）的实施-为历史上获得治疗机会较低的人提供服务的组织。方法：我们调查了2021年在美国运营的所有已知SSP（N = 421），其中77%（n = 325）做出了回应。我们计算了2020年在SSP实施远程医疗丁丙诺啡诱导的流行率和95%置信区间（CI）。多变量逻辑回归用于评估组织特征在实施远程医疗丁丙诺啡诱导方面的差异。结果：2020年，通过远程医疗实施丁丙诺啡诱导的流行率为24%（95%CI：19-30%）。与政府SSP相比，非政府SSP的远程医疗丁丙诺啡诱导几率更高（调整后的比值比（aOR）= 2.92; 95% CI：1.22-7.00; p = 0.016）。此外，组织的年度预算越大，远程医疗丁丙诺啡实施的几率就越高（aOR = 2.00每四分位数（95% CI：1.33-2.99; p = 0.001）。SSP位于阿片类药物过量死亡率较高的国家没有显着更高的可能性，远程医疗buprenorphine implementation.Conclusion：大量的SSP实施远程医疗buprenorphine后，放弃瑞安海特法案。永久采用这一豁免将是至关重要的，为SSP提供财政资源对于支持新创新的实施至关重要。
Introduction: Among people with an opioid use disorder in the United States, only 10% receive buprenorphine treatment. The Ryan Haight Act is a federal law that has regulated buprenorphine delivery, requiring an in-person examination between a patient and provider before initiating treatment. At the beginning of the COVID-19 pandemic, federal agencies waived in-person examination requirements for buprenorphine treatment initiation. We examined whether Ryan Haight Act waiver improved implementation of telehealth buprenorphine within syringe service programs (SSPs) - organizations that serve people with historically low access to treatment.Methods: We surveyed all known SSPs operating in the US in 2021 (N = 421) of which 77% responded (n = 325). We calculated the prevalence and accompanying 95% confidence intervals (CI) for implementation of telehealth buprenorphine inductions at SSPs in 2020. Multivariable logistic regression was used to assess differences in implementing telehealth buprenorphine inductions by organizational characteristics.Results: In 2020, the prevalence of implementing buprenorphine inductions via telehealth was 24% (95% CI:19-30%). Non-governmental SSPs had a higher odds of telehealth buprenorphine inductions (adjusted odds ratio (aOR) = 2.92; 95% CI:1.22-7.00; p = 0.016), compared to governmental SSPs. Furthermore, the larger the organization's annual budget, the higher the odds of telehealth buprenorphine implementation (aOR = 2.00 per quartile (95% CI:1.33-2.99; p = 0.001). SSPs located in states with higher opioid overdose mortality rates did not have significantly higher likelihood of telehealth buprenorphine implementation.Conclusion: A substantial number of SSPs implemented telehealth buprenorphine after waiver of the Ryan Haight Act. Permanent adoption of this waiver will be critical and providing financial resources to SSPs is vital to support implementation of new innovations.