Geographic Distribution of Providers With a DEA Waiver to Prescribe Buprenorphine for the Treatment of Opioid Use Disorder: A 5-Year Update
Geographic Distribution of Providers With a DEA Waiver to Prescribe Buprenorphine for the Treatment of Opioid Use Disorder: A 5-Year Update
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DOI：
10.1111/jrh.12307
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发表时间：
2019-01-01
影响因子：
4.9
通讯作者：
Larson, Eric H.
中科院分区：
文献类型：
--
作者：
Andrilla, C. Holly A.;Moore, Tessa E.;Larson, Eric H.
目的阿片类药物使用障碍（OUD）是一个严重的公共卫生问题。丁丙诺啡是治疗OUD的有效药物辅助治疗（MAT），但患者难以获得，特别是在农村地区。为了改善获得机会，2016年的《综合成瘾和康复法》扩大了获得缉毒局（DEA）豁免的能力，规定丁丙诺啡治疗护士执业者（NP）和医生助理（PA）。这项研究总结了2017年底豁免医生，NP和PA的地理分布，并将其与5年前豁免医生的分布进行了比较。方法使用DEA列表的供应商与豁免规定丁丙诺啡治疗OUD和地区卫生资源文件，我们分配豁免供应商的县在4个地理类别之一。我们计算了每个类别中没有豁免供应商的县的数量，以及县供应商与人口的比例，然后将我们的结果与2012年的豁免劳动力进行了比较。结果-自2012年以来，所有地理类别的医生与DEA豁免提供办公室为基础的MAT的可用性增加。超过一半的农村县（56.3%）仍然缺乏供应商，低于2012年的67.1%。近三分之一（29.8%）的农村美国人和2.2%的城市美国人生活在没有丁丙诺啡提供者的县。在56个县（43个农村），国家方案和保护区增加了其他方面缺乏治疗的情况。结论：总体而言，MAT的可及性有所改善，但农村社区仍然存在治疗差异。
Purpose Opioid use disorder (OUD) is a substantial public health problem. Buprenorphine is an effective medication-assisted treatment (MAT) for OUD, but access is difficult for patients, especially in rural locations. To improve access, the Comprehensive Addiction and Recovery Act of 2016 extended the ability to get a Drug Enforcement Administration (DEA) waiver to prescribe buprenorphine to treat OUD to nurse practitioners (NPs) and physician assistants (PAs). This study summarizes the geographic distribution of waivered physicians, NPs, and PAs at the end of 2017 and compares it to the distribution of waivered physicians 5 years earlier. Methods Using the DEA list of providers with a waiver to prescribe buprenorphine to treat OUD and the Area Health Resources File, we assigned waivered providers to counties in 1 of 4 geographic categories. We calculated the number of counties in each category that did not have a waivered provider and county provider to population ratios and then compared our results to the waivered workforce in 2012. Findings The availability of a physician with a DEA waiver to provide office-based MAT has increased across all geographic categories since 2012. More than half of all rural counties (56.3%) still lack a provider, down from 67.1% in 2012. Almost one-third (29.8%) of rural Americans compared to 2.2% of urban Americans live in a county without a buprenorphine provider. NPs and PAs add otherwise lacking treatment availability in 56 counties (43 rural). Conclusions Overall, MAT access has improved, but rural communities still experience treatment disparities.