Methadone Access for Opioid Use Disorder During the COVID-19 Pandemic Within the United States and Canada.
Methadone Access for Opioid Use Disorder During the COVID-19 Pandemic Within the United States and Canada.
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DOI：
10.1001/jamanetworkopen.2021.18223
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发表时间：
2021-07-01
影响因子：
13.8
通讯作者：
Edelman EJ
中科院分区：
文献类型：
--
作者：
Joudrey PJ;Adams ZM;Bach P;Van Buren S;Chaiton JA;Ehrenfeld L;Guerra ME;Gleeson B;Kimmel SD;Medley A;Mekideche W;Paquet M;Sung M;Wang M;You Kheang ROO;Zhang J;Wang EA;Edelman EJ
在COVID-19期间，美国和加拿大如何比较及时获得美沙酮治疗阿片类药物使用障碍？在这项对美国13个州、哥伦比亚特区和加拿大3个阿片类药物过量死亡率最高的省份的美沙酮诊所进行的2019冠状病毒病期间的横断面研究中，超过十分之一的诊所不接受患者，其中三分之一的诊所报告这是由于COVID-19。加拿大诊所的预约速度比美国诊所快。这些发现表明，美沙酮的可及性可能比之前估计的更糟，并因COVID-19而加剧，加拿大诊所可能比美国阿片类药物治疗项目更及时地提供可及性。本横断面研究调查了美国和加拿大接受阿片类药物使用障碍新患者的诊所比例和首次预约的时间。在2019冠状病毒病疫情期间，美沙酮的获取可能特别容易受到干扰，即使获得美沙酮的短暂延迟也与开始用药减少、非法阿片类药物使用和过量死亡增加有关。与加拿大相比，美国的美沙酮供应更受限制，仅限于专门的阿片类药物治疗方案。比较美国和加拿大在COVID-19期间美沙酮起始治疗的及时可及性。本横断面研究于2020年5月至6月进行。在阿片类药物过量死亡率最高的美国14个州和地区以及加拿大3个省，参与诊所为阿片类药物使用障碍提供美沙酮。统计分析时间为2020年7月至2021年1月。国家和类型的医疗保险（美国医疗补助和美国自付vs加拿大省级）。接受新病人的诊所比例和首次预约的天数。在作为医疗补助患者联系的298家美国诊所中的268家（90%），作为自费患者联系的301家美国诊所中的271家（90%），以及作为省级保险患者联系的288家加拿大诊所中的237家（82%）中，在美国医疗补助联系期间，231家诊所（86%）接受了新患者美沙酮，在美国自费联系期间，230家诊所（85%）接受了新患者，在加拿大联系期间，210家诊所（89%）接受了新患者。在不接受新患者的27家诊所中，至少有44%的诊所报告说，新冠肺炎大流行是原因。美国医疗补助接触者（3.5天[95% CI， 2.9-4.2天]）和美国自费接触者（4.1天[95% CI， 3.4-4.8天]）首次预约的平均等待时间大于加拿大接触者（1.9天[95% CI， 1.7-2.1天]）（P < .001）。57个医疗补助（30%）、57个自费（30%）和115个加拿大（59%）提供预约的联系人报告了开放获取模式（新患者无需预约）的使用情况。在这两个国家的横断面研究中，超过十分之一的美沙酮诊所不接受新患者。加拿大的诊所比美国的阿片类药物治疗项目更及时地提供美沙酮治疗。这些结果表明，COVID-19加剧了美沙酮获取短缺，需要改变美国阿片类药物治疗方案模式，以提高获取的及时性。增加开放存取模式的采用可能会增加及时存取。
How does timely methadone access for opioid use disorder compare between the US and Canada during COVID-19? In this cross-sectional study of methadone clinics during COVID-19 in 13 US states and the District of Columbia and 3 Canadian provinces with the highest rates of opioid overdose deaths, more than 1 in 10 clinics were not accepting patients, one-third of which reported this was due to COVID-19. Canadian clinics offered appointments faster than US clinics. These findings suggest that methadone access may be worse than previously estimated and exacerbated by COVID-19 and that Canadian clinics may provide timelier access than US opioid treatment programs. This cross-sectional study examines the proportion of clinics accepting new patients with opioid use disorder and time until first appointment in the US and Canada. Methadone access may be uniquely vulnerable to disruption during COVID-19, and even short delays in access are associated with decreased medication initiation and increased illicit opioid use and overdose death. Relative to Canada, US methadone provision is more restricted and limited to specialized opioid treatment programs. To compare timely access to methadone initiation in the US and Canada during COVID-19. This cross-sectional study was conducted from May to June 2020. Participating clinics provided methadone for opioid use disorder in 14 US states and territories and 3 Canadian provinces with the highest opioid overdose death rates. Statistical analysis was performed from July 2020 to January 2021. Nation and type of health insurance (US Medicaid and US self-pay vs Canadian provincial). Proportion of clinics accepting new patients and days to first appointment. Among 268 of 298 US clinics contacted as a patient with Medicaid (90%), 271 of 301 US clinics contacted as a self-pay patient (90%), and 237 of 288 Canadian clinics contacted as a patient with provincial insurance (82%), new patients were accepted for methadone at 231 clinics (86%) during US Medicaid contacts, 230 clinics (85%) during US self-pay contacts, and at 210 clinics (89%) during Canadian contacts. Among clinics not accepting new patients, at least 44% of 27 clinics reported that the COVID-19 pandemic was the reason. The mean wait for first appointment was greater among US Medicaid contacts (3.5 days [95% CI, 2.9-4.2 days]) and US self-pay contacts (4.1 days [95% CI, 3.4-4.8 days]) than Canadian contacts (1.9 days [95% CI, 1.7-2.1 days]) (P < .001). Open-access model (walk-in hours for new patients without an appointment) utilization was reported by 57 Medicaid (30%), 57 self-pay (30%), and 115 Canadian (59%) contacts offering an appointment. In this cross-sectional study of 2 nations, more than 1 in 10 methadone clinics were not accepting new patients. Canadian clinics offered more timely methadone access than US opioid treatment programs. These results suggest that the methadone access shortage was exacerbated by COVID-19 and that changes to the US opioid treatment program model are needed to improve the timeliness of access. Increased open-access model adoption may increase timely access.
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影响因子：
5.5
作者：
Huhn AS;Strain EC;Jardot J;Turner G;Bergeria CL;Nayak S;Dunn KE
通讯作者：
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影响因子：
5.7
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5.5
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3.9
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影响因子：
39.2
作者：
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通讯作者：
Barnett, Michael L.