Midwestern changes in substance use and treatment during the COVID-19 pandemic

新冠肺炎大流行导致了广泛的卫生和医疗保健政策变化，包括围绕物质使用障碍的政策变化。早期指标表明，药物使用可能正在增加，但医疗保健政策的变化可能有助于遏制这种增长。对远程保健用于治疗药物使用障碍和分发治疗阿片类药物使用障碍的限制已经放宽。这种变化可能对当地供应商稀少的农村地区特别有帮助。目前的提案将调查药物使用的变化，评估远程保健在治疗药物使用障碍方面的使用和有效性，同时探讨农村或城市地点在这些趋势中的作用。拟议的研究将通过三个目标来完成。在第一个目标中，将查询电子医疗记录，以确定中西部地区2019年3月至2021年4月期间酒精、阿片类药物或兴奋剂使用障碍或过量的患者。人口变量、经济变量和美国农业部农村/城市分类将包括在分析中。这一目标将有助于确定在动态变化时期整个农村/城市范围内药物使用措施的趋势。在第二个目标中，将评估远程保健在治疗药物使用障碍方面的使用和有效性。鉴于距离提供者近常常被认为是农村地区药物使用治疗的障碍，本目标将评估整个农村/城市连续体远程保健的有效性。在第三个目标中，丁丙诺啡治疗阿片类药物使用障碍的变化将被调查。鉴于许可的稀缺性

The SAR-CoV-2 pandemic has contributed to widespread health and healthcare policy changes, including that surrounding substance use disorders. Early indicators suggest that substance use may be increasing, but healthcare policy changes may help counter this increase. Restrictions on telehealth use for the treatment of substance use disorders and the dispensing of drugs to treat opioid use disorder have been eased. This change may be particularly helpful in rural areas where local providers are sparse. The current proposal will investigate changes in substance use and evaluate telehealth's use and effectiveness for the treatment of substance use disorders while exploring the role of rural or urban locations in these trends. The proposed studies will be accomplished through three aims. In the first aim, electronic medical records will be queried to identify patients with alcohol, opioid, or stimulant use disorder or overdoses during the time period encompassing March 2019-April 2021 in the Midwest. Demographic variables, economic variables, and USDA rural/urban classification will be included in the analysis. This aim will help determine trends in drug use measures across the rural/urban spectrum during a period of dynamic change. In the second aim, the use and effectiveness of telehealth for the treatment of substance use disorders will be evaluated. Given the proximity to providers is often cited as barriers to substance use treatment in rural locations, this aim will evaluate the effectiveness of telehealth across the rural/urban continuum. In the third aim, changes in buprenorphine treatment for opioid use disorder will be investigated. Given the sparsity of licensed buprenorphine providers in the rural Midwest, this aim will also examine the use and effectiveness of telehealth for delivering buprenorphine treatment in underserved counties. The resulting findings will provide a better understanding of substance use disorders across the urban and rural continuum while providing critical information to guide healthcare policies related to telehealth usage to treat substance use disorders. The resulting findings will be crucial in developing precision medicine to treat substance use disorder in urban and rural locations.