Evaluation of Low Threshold Buprenorphine Treatment in the Context of COVID-19

项目摘要/摘要 丁丙诺啡是治疗阿片类药物使用障碍的循证药理学方法 (有声)。尽管丁丙诺啡有效，但它的利用严重不足，部分原因是 历来对治疗进入和继续治疗的严格要求。为了解决这一担忧， 最近有人呼吁建立“低门槛”护理，以消除治疗障碍 提高整体准入水平。新冠肺炎疫情给人们带来了前所未有的压力 美国人口和医疗保健系统。社会疏远措施现在已经到位，以 减少病毒传播的风险。虽然这些公共卫生政策可能会防止 感染新冠肺炎，他们也有可能扰乱药物使用的治疗 精神障碍，特别是OUD，严重依赖面对面的医疗保健服务。在……里面 为了回应这些担忧，已经发布了新的指导方针，以鼓励更大的灵活性 在丁丙诺啡的处方中。这些变化有可能增加对 然而，丁丙诺啡对患有OUD的患者的治疗仍然成功。 未知与新冠肺炎相关的系统性变化可能会如何影响 丁丙诺啡的处方、治疗利用或对患者结局的影响。的目标是 本研究旨在通过一种混合方法来检验这种初步联系。 提供丁丙诺啡治疗和患者层面的新冠肺炎大流行 最大医院附属的三家丁丙诺啡门诊的结果 罗德岛州的系统。通过这份特别利益通知(NOSI)， 拟议的研究将捕捉和描述正在发生的对时间敏感的变化 丁丙诺啡治疗新冠肺炎所致。通过这项研究获得的信息将 确定可能影响低门槛方法实施的关键因素 新冠肺炎大流行。此外，该提案寻求对a)更改进行经验性评估 丁丙诺啡处方做法和治疗，以及b)如何改变提供护理的方式 影响患者水平的结果。这项研究的结果可以作为最佳实践的参考。 丁丙诺啡处方指南以确保OUD治疗的安全性和有效性。这个 本申请中概述的目标与Cobre关于阿片类药物和 通过指导初级调查人员解决阿片类药物危机过量，以便他们可以 过渡到独立的临床研究人员，专注于开发和评估 OUD的循证治疗。

PROJECT SUMMARY/ABSTRACT Buprenorphine is an evidence-based pharmacological approach to treating opioid use disorder (OUD). Despite its efficacy, buprenorphine is significantly underutilized, in part, because of historically rigid requirements for treatment entry and continuation. To address this concern, there have been recent calls to establish “low threshold” care to remove barriers to treatment and improve overall access. The COVID-19 pandemic has placed an unprecedented strain on the U.S. population and healthcare system. Social distancing measures are now in place to mitigate the risk of viral transmission. While these public health policies may protect against contracting COVID-19, they also have the potential to disrupt treatment for substance use disorders, particularly OUD, which relies heavily on face-to-face healthcare delivery. In response to such concerns, new guidelines have been released to encourage greater flexibility in the prescribing of buprenorphine. These changes have the potential to increase access to and success with buprenorphine treatment for individuals with OUD, however, it remains unknown how systematic changes related to COVID-19 may affect the practice of buprenorphine prescribing, treatment utilization, or impact on patient outcomes. The objective of the present study is to examine, through a mixed-method approach, the preliminary association of the COVID-19 pandemic with the provision of buprenorphine treatment and patient-level outcomes across three outpatient buprenorphine clinics affiliated with the largest hospital system in the state of Rhode Island. Through this Notice of Special Interest (NOSI), the proposed study will capture and characterize time-sensitive changes that are occurring to buprenorphine treatment as a result of COVID-19. Information obtained through this study will identify key factors that may influence implementation of a low threshold approach following the COVID-19 pandemic. Additionally, this proposal seeks to empirically evaluate a) changes to buprenorphine prescribing practices and treatment, and b) how changes to the delivery of care impact patient-level outcomes. Results of this study may be leveraged to inform best-practice guidelines for buprenorphine prescribing to ensure safety and efficacy of OUD treatment. The aims outlined within this application align with the overall objectives of COBRE on Opioids and Overdose to address the opioid crisis by mentoring junior investigators so that they may transition into independent clinical researchers focused on the development and evaluation of evidence-based treatment for OUD.