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

美国的阿片类药物过量死亡流行已经持续了20多年。非大都市或农村地区 阿片类药物使用障碍(OUD)治疗能力低下与阿片类药物使用率显著升高有关 服药过量死亡。许多国家增加了治疗机会，以减少阿片类药物发病率，方法是 社区药房为美沙酮维持治疗(MMT)提供美沙酮。MMT一直是 研究最多、使用时间最长的OUD疗法大约有55年以上。联邦法规要求MMT 通过约1,860个经SAMHSA认证的阿片类药物治疗计划之一提供。MMT是 被认为比丁丙诺啡更便宜(更负担得起)，治疗保留率比丁丙诺啡高 对乌德的治疗。因此，MMT是许多OUD患者的首选治疗方案。 然而，OTP的数量有限，现有OTP的能力有限，而且到OTP的旅行距离很远 是获得MMT的主要障碍，特别是对农村和郊区的OUD患者来说。药剂师 都是最值得信赖的医疗保健专业人士之一。大约90%的美国人居住在离社区5英里的范围内 药房。联邦法规允许OTP获得建立美沙酮药物治疗单元(MU)的批准 在药房(药房MU)允许MMT的药房管理和美沙酮配发 扩大治疗。MU由母公司OTP的OTP主管管理，他们负责监督患者的护理 主要的OTP和MU位置。在美国，MU很少被使用。鉴于严重的短缺 为了应对不断升级的阿片类药物过量死亡流行，美国的OUD供应商迫切需要 确定建立MU的有用策略，并传播建立MU的有用策略 在全国范围内提供给OTP主任和美国的社区药剂师。 借鉴皮(吴)博士培养医师-社区药师的成功经验 协作式护理模式，让社区药剂师提供丁丙诺啡治疗护理 使用OUD(Wu等人，2021A)和美沙酮治疗MMT的患者(Wu等人， 2021b)，我们将对OTP主任(n=586)和社区药剂师(n=586)进行调查，以确定OTP 和社区药房设施/实践、个人和与意图相关的背景因素 建立一个MU。在混合方法解释性序贯设计的指导下，我们还将进行后续研究 对每项调查的部分参与者进行定性访谈，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供应商的严重短缺和阿片类药物死亡率的不断上升，这项研究具有时间敏感性。 这项研究将是美国第一次从OTP和OTP两个方面确定MU实施的障碍和促进者 董事和药剂师。我们将制作多份同行评议的出版物和一个电子工具包 建立MU，以便将工具包和出版物迅速分发给OTP主任和全国药剂师。

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.