Substance Use Disorder Treatment Availability Among States Considering Medicaid Work Requirements.
Substance Use Disorder Treatment Availability Among States Considering Medicaid Work Requirements.
复制标题
考虑医疗补助工作要求的各州的药物使用障碍治疗可用性。
DOI：
10.1007/s11606-019-05623-1
复制
发表时间：
2020
影响因子：
5.7
通讯作者：
Tipirneni,Renuka
中科院分区：
文献类型：
--
作者：
Christine,PaulJ;Tipirneni,Renuka
方法我们比较了SUD患病率，所有过量死亡，阿片类药物过量死亡和SUD治疗的可用性跨工作要求类别（批准，待定，或没有工作要求的状态）。数据来源如下：工作要求政策（Kaiser Family Foundation，1 National Academy for State Health Policy 2）; SUD患病率（全国药物使用和健康调查）;阿片类药物过量死亡（CDC WONDER）;州人口（美国人口普查）; SUD治疗机构数据，包括接受医疗补助支付，提供阿片类药物治疗计划和提供阿片类药物维持治疗（OMT）（全国药物滥用治疗服务调查）;豁免为阿片类药物使用障碍开具丁丙诺啡处方的持牌处方者数量（药物滥用和精神卫生服务管理局[SAMHSA]提供者定位器）。于2019年9月使用SAS（版本9.4）在州一级进行分析，并酌情进行t检验或Wilcoxon检验。所有数据（工作要求状态除外）均与2017年有关。该研究被视为免于IRB批准。SUD的患病率在有和没有医疗补助工作要求的州之间相似（表1）。然而，与等待或没有工作要求的州相比，批准医疗补助工作要求豁免的州在总体和阿片类药物相关过量死亡方面的负担更高。
METHODSWe compared SUD prevalence, all overdose deaths, opioid overdose deaths, and SUD treatment availability across work requirement categories (approved, pending, or no work requirement in the state). Data sources were as follows: work requirement policies (Kaiser Family Foundation, 1 National Academy for State Health Policy 2); SUD prevalence (National Survey on Drug Use and Health); opioid overdose deaths (CDC WONDER); state population (US Census); SUD treatment facility data, including acceptance of Medicaid payment, offering opioid treatment program, and offering opioid maintenance therapy (OMT)(National Survey of Substance Abuse Treatment Services); number of licensed prescribers with waiver to prescribe buprenorphine for opioid use disorder (Substance Abuse and Mental Health Service Administration [SAMHSA] provider locator). Analyses were conducted at the state level using SAS (version 9.4) in September 2019, with t tests or Wilcoxon tests as appropriate. All data (except work requirement status) pertained to 2017. The study was deemed exempt from approval by the IRB.RESULTSPrevalence of SUD was similar across states with and without Medicaid work requirements (Table 1). However, states with approved Medicaid work requirement waivers had a higher burden of both overall and opioid-related overdose deaths, compared with states with pending or no work requirements.