Tracking the geographic distribution and growth of clinicians with a DEA waiver to prescribe buprenorphine to treat opioid use disorder
Tracking the geographic distribution and growth of clinicians with a DEA waiver to prescribe buprenorphine to treat opioid use disorder
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DOI：
10.1111/jrh.12569
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发表时间：
2021-03-18
影响因子：
4.9
通讯作者：
Patterson, Davis G.
中科院分区：
文献类型：
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作者：
Andrilla, C. Holly A.;Patterson, Davis G.
目的丁丙诺啡是治疗阿片类药物使用障碍(Moud)的有效药物，但患者难以获得，尤其是在农村地区。为了改善获取途径，包括《全面成瘾和康复法》(2016)和《预防药物使用障碍法》(促进阿片类药物康复和治疗患者和社区(支持)法)(2018)在内的立法，将获得药品执行管理局(DEA)豁免开出丁丙诺啡治疗阿片使用障碍(OUD)的能力扩大到多种类型的临床医生。这项研究更新了截至2020年7月的豁免临床医生的分布，并注意到地区和地理上的差异。方法使用2020年7月药品监督管理局豁免开丁丙诺啡治疗的提供者名单，我们将豁免临床医生分配到四个地理类别中的一个县。我们计算了每个类别中没有豁免临床医生的县的数量、可用的治疗时段以及县提供者与人口的比率。结果发现，从2017年12月到2020年7月，免除DEA的临床医生的数量增加了一倍多，从37,869人增加到98,344人。拥有DEA豁免的临床医生提供Moud的可能性在所有地理类别中都有所增加。近三分之二的农村县(63.1%)至少有一名临床医生拥有DEA豁免，但超过一半的小而偏远的农村县缺乏临床医生。美国人口普查部门在可获得性方面也存在显著差异。结论总体上，穆德可获得性有所改善，但小型农村社区仍存在治疗差异，且存在显著的地区差异。
Purpose Buprenorphine is an effective medication treatment for opioid use disorder (MOUD) but access is difficult for patients, especially in rural locations. To improve access, legislation, including the Comprehensive Addiction and Recovery Act (2016) and the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act (2018), extended the ability to get a Drug Enforcement Administration (DEA) waiver to prescribe buprenorphine to treat opioid use disorder (OUD) to numerous types of clinicians. This study updates the distribution of waivered clinicians as of July 2020 and notes regional and geographic differences.Methods Using the July 2020 Drug Enforcement Administration list of providers with a waiver to prescribe buprenorphine to treat OUD, we assigned waivered clinicians to counties in one of four geographic categories. We calculated the number of counties in each category that did not have a waivered clinician, available treatment slots, and the county provider to population ratios.Findings The number of DEA-waivered clinicians more than doubled between December 2017 and July 2020 from 37,869 to 98,344. The availability of a clinician with a DEA waiver to provide MOUD has increased across all geographic categories. Nearly two-thirds of all rural counties (63.1%) had at least one clinician with a DEA waiver but more than half of small and remote rural counties lacked one. There were also significant differences in access by the US Census Division.Conclusions Overall, MOUD access has improved, but small rural communities still experience treatment disparities and there is significant regional variation.