Liberating methadone: Building a roadmap and community for change

项目总结/摘要 随着我们继续面临美国历史上最严重的过量流行病，迫切需要改变政策 扩大循证治疗的可及性，以防止过量死亡。美沙酮维持 MMT在治疗阿片类药物使用障碍（OUD）方面非常有效，并将过量风险降低了50%以上。 然而，MMT在美国仍然没有得到充分利用。自20世纪70年代以来，MMT在美国只能用于OUD。 通过在高度结构化的阿片类药物治疗计划（OTP）中每日分发药物来访问。刚性 管理OTP的法规极大地限制了它们的可用性，并使治疗经验 对患者来说是一个沉重的负担和耻辱。几十年来，这个系统一直被描述为一种 “液体手铐”，使现有患者降级，并阻止新患者参与治疗。 这是50年来第一次，我们正处于一个历史性的时刻，可能会改变MMT的交付过程， 美国：联邦政策变化以缓解COVID-19风险，包括增加带回家的灵活性 美沙酮剂量，引发了关于必要的MMT改革的讨论，包括扩大美沙酮 分发给药房。然而，为了指导这种改革，并为更公平和更容易获得的开放式发展提供信息， 治疗系统，需要收集科学证据，临床专业知识和生活经验， 接受MMT的人为此，纽约大学格罗斯曼医学院计划举办为期1.5天的会议 2023年7月，在纽约市举行了题为“解放美沙酮：建立变革的路线图和社区”的会议。 本次会议将提供一个独特而及时的机会，将主要合作伙伴聚集在一起，包括 研究人员，临床医生，政策制定者和使用药物的人-讨论过去，现在和未来， MMT为OUD。这种面对面/虚拟的混合会议将刺激创新研究并建立凝聚力 跨多个群体，为更具包容性的研究合作和政策改革奠定基础， 满足受过量用药危机影响最严重的人的需求。通过研究报告、小组讨论 讨论和政策工作组，会议将：（1）讨论第一手经验， 患者在当前的OTP系统和需要一个更容易获得，公平和以人为本 （2）为创新研究和不同领域之间的新型合作创造机会 通过审查现有证据和关于美国现行MMT系统的知识差距， （3）起草和传播研究、实践和政策 建议推进必要的改革，以扩大检察官办公室系统以外的贪污腐败问题法庭。会议将 支持NIDA的优先研究领域，以应用科学来推进政策，培养真正的社区- 通过汇集来自不同地理、种族和文化背景的广泛利益相关者， 种族背景和生活经验，最重要的是，促进创新，以改善获得 到拯救生命和人性化的治疗和护理。

PROJECT SUMMARY/ABSTRACT As we continue to face the worst overdose epidemic in U.S history, urgent policy changes are needed to expand access to evidence-based treatment to prevent overdose deaths. Methadone maintenance treatment (MMT) is highly effective at treating opioid use disorder (OUD) and cuts overdose risk by over 50%. And yet, MMT remains vastly under-utilized in the U.S. Since the 1970s, MMT for OUD in the U.S. can only be accessed via daily dispensing of medication at highly structured Opioid Treatment Programs (OTPs). Rigid regulations governing OTPs have greatly limited their availability, and have made the treatment experience highly burdensome and stigmatizing for patients. For decades, this system has been described as a form of “liquid handcuffs,” which degrades existing patients and deters new patients from engaging in treatment. For the first time in 50 years, we are at a historic moment that could alter the course of MMT delivery in the U.S.: Federal policy changes to alleviate COVID-19 risks, including increased flexibility for take-home methadone doses, instigated discussions about needed MMT reforms, including expanding methadone dispensing to pharmacies. However, to guide such reforms and inform a more equitable and accessible OUD treatment system, there is a need to gather the scientific evidence, clinical expertise, and lived experience of people receiving MMT. To this end, the NYU Grossman School of Medicine aims to host a 1.5-day conference in July of 2023 in NYC titled “Liberating Methadone: Building a roadmap and community for change.” This conference will provide a unique and timely opportunity to bring together key partners - including researchers, clinicians, policy makers and people who use drugs - to discuss the past, present and future of MMT for OUD. This hybrid in-person/virtual conference will stimulate innovative research and build cohesion across multiple groups, setting the stage for more inclusive research collaborations and policy reforms that meet the needs of the people most affected by the overdose crisis. Through research presentations, panel discussions, and policy working groups, conference sessions will: (1) Discuss the first-hand experiences of patients in the current OTP system and the need for a more accessible, equitable and person-centered treatment system; (2) Create opportunities for innovative research and novel collaborations among diverse partners by reviewing the existing evidence and gaps in knowledge regarding the current U.S. MMT system and alternative methadone delivery models; and (3) Draft and disseminate research, practice and policy recommendations to advance reforms needed to expand MMT beyond the OTP system. The conference will support NIDA priority research areas for the application of science to advance policy, foster true community- engaged research by bringing together a wide array of stakeholders from diverse geographies, racial and ethnic backgrounds, and life experiences, and most importantly, promote innovation towards improving access to life-saving and humanizing treatment and care.