The Evidence Doesn't Justify Steps By State Medicaid Programs To Restrict Opioid Addiction Treatment With Buprenorphine
The Evidence Doesn't Justify Steps By State Medicaid Programs To Restrict Opioid Addiction Treatment With Buprenorphine
复制标题
DOI：
10.1377/hlthaff.2010.0532
复制
发表时间：
2011-08-01
期刊：
影响因子：
9.7
通讯作者：
Leung, Gary Y.
中科院分区：
文献类型：
--
作者：
Clark, Robin E.;Samnaliev, Mihail;Leung, Gary Y.
许多州的医疗补助计划限制获取丁丙诺啡，这是一种能缓解海洛因或其他阿片类药物成瘾者戒断症状的处方药。原因是官员们担心这种药物比美沙酮等其他疗法更昂贵或安全性更低。为了查明情况是否属实，我们比较了2003年至2007年期间33923名马萨诸塞州医疗补助受益人在接受丁丙诺啡、美沙酮、无药物治疗或未接受治疗时的支出、与药物使用复发相关的服务使用情况以及死亡率。丁丙诺啡似乎显著扩大了治疗途径，因为与美沙酮相比，它可以由医生开处方并在家中服用，而根据法律，美沙酮必须在经批准的诊所使用。在用于维持治疗时，丁丙诺啡与更多复发相关服务有关，但平均每年支出比美沙酮低1330美元。丁丙诺啡和美沙酮的死亡率相似。相比之下，与接受丁丙诺啡治疗的人相比，接受无药物治疗的人的死亡率高出75%，未接受治疗的人的死亡率则高出一倍多。证据不支持为了省钱或确保安全而对丁丙诺啡进行配给。
Many state Medicaid programs restrict access to buprenorphine, a prescription medication that relieves withdrawal symptoms for people addicted to heroin or other opiates. The reason is that officials fear that the drug is costlier or less safe than other therapies such as methadone. To find out if this is true, we compared spending, the use of services related to drug-use relapses, and mortality for 33,923 Massachusetts Medicaid beneficiaries receiving either buprenorphine, methadone, drug-free treatment, or no treatment during the period 2003-07. Buprenorphine appears to have significantly expanded access to treatment because the drug can be prescribed by a physician and taken at home compared with methadone, which by law must be administered at an approved clinic. Buprenorphine was associated with more relapse-related services but $1,330 lower mean annual spending than methadone when used for maintenance treatment. Mortality rates were similar for buprenorphine and methadone. By contrast, mortality rates were 75 percent higher among those receiving drug-free treatment, and more than twice as high among those receiving no treatment, compared to those receiving buprenorphine. The evidence does not support rationing buprenorphine to save money or ensure safety.