Increasing access to medication-assisted treatment: Interactions between federal and state workforce policies

摘要/项目摘要 阿片类药物使用障碍的药物治疗是减少高社会负担努力的重要组成部分 处方药和非处方药滥用阿片类药物的成本和死亡率。这种方法结合了 药物疗法(如丁丙诺啡、美沙酮、纳曲酮)作为阿片依赖治疗的一部分。 丁丙诺啡的有效性已经在许多研究中得到证实，可以在办公室开出 环境；因此，丁丙诺啡对于扩大获得药物治疗的机会特别重要。 阿片类药物使用障碍。然而，对治疗的需求大大超过了授权的提供者数量。 开出药方，农村地区的医疗服务提供者尤其严重短缺。美国许多县都没有 单一提供商。 为了应对丁丙诺啡处方医生的短缺，#年制定了两项联邦劳动力政策 2016年：(1)允许执业护士和医生助理获得开丁丙诺啡处方的授权 在办公室环境中，以及(2)增加可以开出的最大病人数量 丁丙诺啡由内科医生在100至275年间使用。2018年通过的立法允许其他高级执业护士 (护士-助产士、临床护士专科医生和护士-麻醉师)也开丁丙诺啡。这些 预计政策将增加数千人获得阿片类药物使用障碍的药物治疗 个人。然而，这些政策实现其目标的程度将取决于其他环境因素 以及政策因素，最重要的是规范高级执业临床医生用药处方的州法律。 拟议的研究将评估这些劳动力政策对供应和地理覆盖范围的影响 阿片类药物治疗提供者，重点是国家政策是否以及如何促进或阻碍 可用的处方医生。具体目标是： 目标1：衡量2016年和2018年制定的联邦政策对数字和 丁丙诺啡豁免的临床医生的地理分布。 目标2：确定国家级业务范围条例是否持续缓和有效性 实施旨在增加丁丙诺啡治疗机会的联邦政策。 目标3：评估授权开处方的临床医生的数量和类型是否扩大 丁丙诺啡与更多丁丙诺啡的分配有关。 2016年至2022年来自多个来源的数据将使用计量经济学方法进行分析，这些方法 解决可能影响丁丙诺啡处方者和使用量增长的法规中的州差异 同时控制可能影响政策执行的其他法规和方案。由此得出的结论 研究可以用来促进州和联邦解决阿片类药物危机的努力的协调。 在美国和受影响严重的地区。

ABSTRACT / PROJECT SUMMARY Medication treatment for opioid use disorder is an important component of efforts to reduce the high social costs of prescription and non-prescription opioid abuse and mortality. This approach incorporates pharmacotherapies (e.g., buprenorphine, methadone, naltrexone) as part of treatment for opioid dependence. Buprenorphine’s effectiveness has been established in numerous studies and can be prescribed in office-based settings; thus, buprenorphine is particularly important to the expansion of access to medication treatment for opioid use disorder. However, the need for treatment dramatically outstrips the number of providers authorized to prescribe it, with particularly severe shortages of providers in rural areas. Many U.S. counties do not have a single provider. In response to the shortage of buprenorphine prescribers, two federal workforce policies were established in 2016: (1) allowing nurse practitioners and physician assistants to become authorized to prescribe buprenorphine in office-based settings, and (2) increasing the maximum number of patients that can be prescribed buprenorphine by a physician from 100 to 275. Legislation passed in 2018 allows other advanced practice nurses (nurse-midwives, clinical nurse specialists, and nurse-anesthetists) to prescribe buprenorphine as well. These policies are expected to increase access to medication treatment for opioid use disorder for thousands of individuals. However, the degree to which these policies achieve their goal will depend on other environmental and policy factors, most importantly state laws that regulate advanced practice clinicians’ medication prescribing. The proposed study will assess the impacts of these workforce policies on the supply and geographic reach of opioid treatment providers, with a focus on whether and how state policies facilitate or impede growth in available prescribers. The specific aims are: Aim 1: To measure the degree to which federal policies established in 2016 and 2018 impact the number and geographic distribution of clinicians with buprenorphine waivers. Aim 2: To determine whether state-level scope of practice regulations persistently moderate the effectiveness of federal policies aimed at increasing access to buprenorphine treatment. Aim 3: To assess whether expansions of the number and types of clinicians authorized to prescribe buprenorphine are associated with greater dispensing of buprenorphine. Data from multiple sources from 2016 through 2022 will be analyzed using econometric approaches that address state variation in regulations that may affect the growth of buprenorphine prescribers and utilization while controlling for other regulations and programs that might affect policy implementation. Findings from this research could be used to promote the harmonization of state and federal efforts to address the opioid crisis across the U.S. and in highly-impacted regions.