Where Is Buprenorphine Dispensed to Treat Opioid Use Disorders? The Role of Private Offices, Opioid Treatment Programs, and Substance Abuse Treatment Facilities in Urban and Rural Counties
Where Is Buprenorphine Dispensed to Treat Opioid Use Disorders? The Role of Private Offices, Opioid Treatment Programs, and Substance Abuse Treatment Facilities in Urban and Rural Counties
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DOI：
10.1111/1468-0009.12137
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发表时间：
2015-09-01
影响因子：
6.6
通讯作者：
Dick, Andrew W.
中科院分区：
文献类型：
--
作者：
Stein, Bradley D.;Pacula, Rosalie Liccardo;Dick, Andrew W.
背景：阿片类药物使用障碍是一个重大的公共卫生问题。 2002 年，FDA 批准丁丙诺啡作为阿片类药物使用障碍的治疗药物，由豁免医生处方，每次只能治疗 30 名患者。 2006 年，联邦立法将这一数字提高到 100 名患者。尽管联邦立法者正在考虑进一步提高这些限制并扩大非医生的处方特权，但有关此类变化对丁丙诺啡使用的影响的信息很少。因此，我们研究了 2006 年立法的影响，以及城乡豁免医生、阿片类药物治疗计划和药物滥用治疗设施之间的关联，对过去十年中人均丁丙诺啡分配的影响。方法：使用 2004-2011 年州级丁丙诺啡配发数据和县级关于丁丙诺啡豁免医生和使用丁丙诺啡的药物滥用治疗机构数量的数据，我们估计了一个多元普通最小二乘回归模型，其中州每年人均配发的丁丙诺啡总量作为该州丁丙诺啡提供者数量的函数的州固定效应。研究结果：丁丙诺啡配发量的增长速度快于丁丙诺啡提供者数量的增长速度。在农村和城市环境中，放弃治疗 100 名丁丙诺啡患者的医生数量与人均丁丙诺啡配药量的增加显着相关。丁丙诺啡分布的增长与 30 名患者豁免的医生数量没有显着关联。结论：丁丙诺啡配发量的增加与阿片类激动剂用于阿片类药物使用障碍治疗的潜在更多使用是一致的，尽管它们也使滥用的可能性更大。 2006 年立法后的变化表明，侧重于增加单个被豁免医生可以安全有效治疗的患者数量的政策可能比开设新的药物滥用治疗设施或增加豁免医生总数等替代方案更有效地增加丁丙诺啡的使用。
Context: Opioid use disorders are a significant public health problem. In 2002, the FDA approved buprenorphine as an opioid use disorder treatment when prescribed by waivered physicians who were limited to treating 30 patients at a time. In 2006, federal legislation raised this number to 100 patients. Although federal legislators are considering increasing these limits further and expanding prescribing privileges to nonphysicians, little information is available regarding the impact of such changes on buprenorphine use. We therefore examined the impact of the 2006 legislation- as well as the association between urban and rural waivered physicians, opioid treatment programs, and substance abuse treatment facilities- on buprenorphine distributed per capita over the past decade. Methods: Using 2004- 2011 state- level data on buprenorphine dispensed and county- level data on the number of buprenorphine- waivered physicians and substance abuse treatment facilities using buprenorphine, we estimated a multivariate ordinary least squares regression model with state fixed effects of a state's annual total buprenorphine dispensed per capita as a function of the state's number of buprenorphine providers. Findings: The amount of buprenorphine dispensed has been increasing at a greater rate than the number of buprenorphine providers. The number of physicians waivered to treat 100 patients with buprenorphine in both rural and urban settings was significantly associated with increased amounts of buprenorphine dispensed per capita. There was no significant association in the growth of buprenorphine distributed and the number of physicians with 30- patient waivers. Conclusions: The greater amounts of buprenorphine dispensed are consistent with the potentially greater use of opioid agonists for opioid use disorder treatment, though they also make their misuse more likely. The changes after the 2006 legislation suggest that policies focused on increasing the number of patients that a single waivered physician could safely and effectively treat could bemore effective in increasing buprenorphine use than would alternatives such as opening new substance abuse treatment facilities or raising the overall number of waivered physicians.