Increasing access to opioid use disorder treatment by opening pharmacy-based medication units of opioid treatment programs

通过开设阿片类药物治疗项目的药房用药单位，增加获得阿片类药物使用障碍治疗的机会

• 批准号: 10679104
• 负责人: Li-Tzy Wu
• 金额: $ 71.83万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-15 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10679104
• 关键词: Address; Admission activity; Agreement; American; Area; Buprenorphine; Burn injury; Canada; Caring; Certification; Communities; Community Pharmacy; Community Physician; Community Surveys; Country; Data; Electronics; Elements; Enrollment; Epidemic; Geography; Health Professional; Health Services Accessibility; Improve Access; Individual; Instruction; Interview; Licensing; Location; Methadone; Methods; Modeling; Morbidity - disease rate; Opioid; Parents; Participant; Patient Care; Patients; Peer Review; Perception; Persons; Pharmaceutical Preparations; Pharmacists; Pharmacy Administration; Pharmacy facility; Physicians; Primary Care Physician; Provider; Publications; Publishing; Regulation; Research; Research Design; Rural; Sampling; Site; Specific qualifier value; Surveys; Time; Travel; Trust; United States Substance Abuse and Mental Health Services Administration; buprenorphine treatment; collaborative care; community engagement; contextual factors; cost effective; design; drug testing; experience; follow-up; implementation barriers; implementation facilitators; medication for opioid use disorder; methadone treatment; nonmetropolitan area; opioid epidemic; opioid mortality; opioid treatment program; opioid use disorder; retention rate; rural area; suburb; willingness; young adult

The US opioid overdose death epidemic has continued for over 20 years. Nonmetropolitan or rural areas with low capabilities of opioid use disorder (OUD) treatment are associated with significantly elevated rates of opioid overdose deaths. Many countries have increased OUD treatment access to reduce opioid morbidity by allowing community pharmacy dispensing of methadone for methadone maintenance treatment (MMT). MMT has been the most studied and longest utilized OUD treatment for about 55+ years. Federal regulations require MMT to be provided through one of about 1,860 SAMHSA certified opioid treatment programs (OTPs). MMT is considered less expensive (more affordable) and has higher treatment retention rates than buprenorphine treatment for OUD. Thus, MMT is a preferred treatment option for many individuals with OUD. However, the limited number of OPTs, limited capabilities of existing OTPs, and a long travel distance to an OTP are major barriers to accessing MMT, especially for persons with OUD in rural and suburban areas. Pharmacists are among the most trusted healthcare professionals. About 90% of Americans live within 5 miles of a community pharmacy. Federal regulations allow OTPs to obtain approvals to establish methadone medication units (MUs) at pharmacies (pharmacy MUs) to allow pharmacy administration and dispensing of methadone for MMT to expand treatment. MUs are managed by OTP directors of the parent OTP who have oversight of patient care at both the main OTP and MU location. MUs have been infrequently utilized in the US. Given the serious shortage of OUD providers in the US to address the escalating opioid overdose death epidemic, there is an urgent need to identify useful strategies of establishing MUs and to disseminate useful strategies of establishing MUs nationally to OTP directors and community pharmacists in the US. Built on the successful experience of the PI’s (Dr. Wu) research on developing physician-community pharmacist collaborative care models to engage community pharmacists in providing buprenorphine treatment care to patients with OUD (Wu et al., 2021a) and administration and dispensing of methadone for MMT (Wu et al., 2021b), we will conduct a survey of OTP directors (n=586) and community pharmacists (n=586) to identify OTP and community pharmacy facility/practice, individual, and contextual factors that are related to intentions to establish a MU. Guided by a mixed methods explanatory sequential design, we will also conduct follow-up qualitative interviews of a subsample of participants from each survey to further obtain in-depth data on MU implementation barriers and facilitators in the US. Due to the serious shortage of OUD providers and escalating rates of opioid deaths, this study is time-sensitive. This study will be the first effort in the US to identify MU implementation barriers and facilitators from both OTP directors and pharmacists. We will produce multiple peer-reviewed publications and an electronic toolkit for establishing MUs to quickly disseminate the toolkit and publications to OTP directors and pharmacists nationally.

美国阿片类药物过量死亡流行持续了20多年。非大都会或粗糙区域 蛋白质使用障碍（OUD）治疗的低功能与绿核酸的速率显着升高有关 过量的死亡。许多国家通过允许使用OUD的治疗方法来减少阿片类药物的发病率 社区药房分配方法载体维护治疗（MMT）。 MMT一直在 研究率最多，使用时间最长的OUD治疗已有55年以上。联邦法规要求MMT 通过约1,860个SAMHSA认证的阿片类药物治疗计划（OTP）提供。 MMT是 被认为比丁丙诺啡较便宜（价格更便宜），并且具有更高的治疗率 Oud的处理。这是MMT对于许多OUD的人来说是首选的治疗选择。 但是，选择数量有限，现有OTP的功能有限，并且距离OTP的距离很长 是进入MMT的主要障碍，尤其是对于在粗糙和郊区的Oud的人来说。药剂师 是最值得信赖的医疗保健专业人员之一。约90％的美国人居住在一个社区5英里以内 药店。联邦法规允许OTP获得批准以建立Metawadone药物单位（MUS） 在药房（药房），允许药房给药和分配MMT 扩大治疗。 MUS由父母OTP的OTP董事管理，他们对患者护理有监督 主要的OTP和MU位置。在美国很少使用MUS。考虑到严重的短缺 美国的Oud提供者解决了不断升级的阿片类药物过量死亡流行病，迫切需要 确定建立MUS并传播建立MUS的有用策略的有用策略 全国与美国的OTP董事和社区药剂师。 建立在PI（WU博士）关于开发物理社区药剂师的成功经验的基础上 协作护理模型，使社区药剂师提供丁丙诺啡治疗护理 OUD（Wu等，2021a）的患者以及MMT的MEDADONE的给药和分配（Wu等人， 2021b），我们将对OTP董事（n = 586）和社区药剂师（n = 586）进行调查，以识别OTP 以及与意图有关的社区药房设施/实践，个人和背景因素 建立一个Mu。在混合方法挖掘顺序设计的指导下，我们还将进行随访 每个调查中参与者的子样本的定性访谈，以进一步获得有关MU的深入数据 美国的实施障碍和促进者。 由于OUD提供者的严重短缺和阿片类药物死亡率的升级，这项研究对时间敏感。 这项研究将是美国第一个努力，以确定两个OTP的MU实施障碍和促进者 董事和药剂师。我们将生产多个同行评审的出版物和一个电子工具包 建立MUS在全国范围内将工具包和出版物迅速传播给OTP董事和药剂师。