Buprenorphine dispensing in an epicenter of the U.S. opioid epidemic: A case study of the rural risk environment in Appalachian Kentucky.
Buprenorphine dispensing in an epicenter of the U.S. opioid epidemic: A case study of the rural risk environment in Appalachian Kentucky.
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DOI：
10.1016/j.drugpo.2020.102701
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发表时间：
2020-11
期刊：
影响因子：
--
通讯作者：
Young AM
中科院分区：
文献类型：
--
作者：
Cooper HL;Cloud DH;Freeman PR;Fadanelli M;Green T;Van Meter C;Beane S;Ibragimov U;Young AM
丁丙诺啡是遏制阿片类药物流行的基石，但新出现的数据表明，美国的农村药剂师有时拒绝分发这种药物。我们进行了一项案例研究，探讨丁丙诺啡配药的做法，在12个农村阿巴拉契亚肯塔基州县，并分析他们是否以及如何形成的农村风险环境的特点。在本案例研究中，我们进行了一对一的半结构化访谈，在这些县经营15家药店的14名药剂师，探讨丁丙诺啡配药的做法和感知这些做法的影响。专题分析结果的成绩单揭示了三个特点的农村风险环境，形成配药。为了探索这三个风险环境特征，我们分析了政策文件（例如，司法部长诉讼）和行政数据库（例如，监禁数据）。文本文件进行了分析，使用主题分析和管理数据进行了分析，使用描述性统计;备忘录探讨风险环境特征和配药做法之间的关系。15家药店中有12家通过拒绝为新患者提供服务来限制配药;限制对已知患者或处方者的配药;或完全拒绝分发丁丙诺啡。对阿片类药物配药超过“缉毒局（DEA）上限”的担忧扼杀了配药。制药公司对阿片类镇痛药（OAs）的积极和欺诈性营销的遗留问题以及医生对OAs的过度处方破坏了药剂师对丁丙诺啡及其处方者的信任。不断升级的地方禁毒战争可能通过加强对吸毒者的污名化而破坏了配药。增加丁丙诺啡处方的举措必须伴随着增加配药的政策变化。具体而言，丁丙诺啡应从阿片类药物监测系统中删除;应将减少毒品战争的努力扩大到包括农村地区;应加强拆除积极OA营销的举措;需要努力重建药剂师对医生的信任。
Buprenorphine is a cornerstone to curbing opioid epidemics, but emerging data suggest that rural pharmacists in the US sometimes refuse to dispense this medication. We conducted a case study to explore buprenorphine dispensing practices in 12 rural Appalachian Kentucky counties, and analyze whether and how they were shaped by features of the rural risk environment. In this case study, we conducted one-on-one semi-structured interviews with 14 pharmacists operating 15 pharmacies in these counties to explore buprenorphine dispensing practices and perceived influences on these practices. Thematic analyses of the resulting transcripts revealed three features of the rural risk environment that shaped dispensing. To explore these three risk environment features, we analyzed policy documents (e.g., Attorney General lawsuits) and administrative databases (e.g., incarceration data). Textual documents were analyzed using thematic analyses and administrative data were analyzed using descriptive statistics; memoes explored relationships among risk environment features and dispensing practices. Twelve of the 15 pharmacies limited dispensing, by refusing to serve new patients; limiting dispensing to known patients or prescribers; or refusing to dispense buprenorphine altogether. Concerns about exceeding a “Drug Enforcement Administration (DEA) cap” on opioid dispensing stifled dispensing. A legacy of aggressive and fraudulent marketing of opioid analgesics (OAs) by pharmaceutical companies and physician OA overprescribing undermined pharmacist trust in buprenorphine and in its prescribers. The escalating local war on drugs may have undermined dispensing by reinforcing stigma against people who use drugs. Initiatives to increase buprenorphine prescribing must be accompanied by policy changes to increase dispensing. Specifically, buprenorphine should be removed from opioid monitoring systems; efforts to de-escalate the war on drugs should be extended to encompass rural areas; initiatives to dismantle aggressive OA marketing should be strengthened; and efforts to re-build pharmacist trust in physicians are needed.
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4.4
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