Opioid Agonist Treatment Expansion in Medicaid: The Role of Buprenorphine

描述（由申请人提供）：阿片类药物使用障碍是一个重大的公共卫生问题，但从历史上看，只有不到25%的阿片类药物依赖个体接受阿片类药物激动剂治疗（OAT），这是对阿片类药物依赖最有效的干预措施，具有广泛的证据基础。丁丙诺啡于2002年获得FDA批准，为临床医生提供了OAT的额外治疗选择，这是除美沙酮分配阿片类药物治疗计划（OTP）之外的另一种选择。然而，我们知道没有研究估计丁丙诺啡在多大程度上真正扩大了OAT的使用，或者诸如医疗补助政策等因素与更大的使用有关。本研究将仔细检查在多种情况下获得BUP维持治疗的相对可及性与在otp中获得美沙酮的相对可及性，以便更好地了解BUP和OAT使用的促进因素和障碍。我们的创新方法利用了几个丰富的互补数据源，其中包含有关OAT的详细信息，包括国家药物滥用治疗服务调查（N-SSATS），医疗补助分析提取（MAX）文件和治疗事件数据集TEDS。我们考虑了社区环境因素和国家政策的作用，它们如何与个人和临床因素相互作用，影响丁丙诺啡的获取和利用，以及在什么治疗环境中发生这种使用。此外，通过考虑基于办公室的阿片类激动剂治疗以及药物滥用治疗设置OAT，我们可以从简单地导致人们改变治疗形式的因素中深入了解实际增加接受OAT的个人总数的因素。我们的研究结果将为决策者提供有关州一级法规和社区一级与OAT（特别是丁丙诺啡）使用率增加相关的促进因素和障碍的关键信息。

DESCRIPTION (provided by applicant): Opioid use disorders are a significant public health problem, yet historically, less than 25% of opioid dependent individuals receive opioid agonist therapy (OAT), the most effective intervention for opioid dependence with a broad evidence base. Buprenorphine, approved by the FDA in 2002, provided clinicians with an additional treatment option for OAT, an option available in settings other than methadone dispensing opioid treatment programs (OTP). Yet we are aware of no studies that estimated the extent to which Buprenorphine truly expanded utilization of OAT, or the factors, such as Medicaid policies, associated with greater use. This study will carefully examine the relative access to BUP maintenance treatment in multiple settings vis-¿-vis access to methadone in OTPs in order to develop a better understanding of facilitators and barriers to utilization of BUP specifically ad OAT more generally. Our innovative approach makes use of several rich complementary data sources that contain detailed information about OAT, including the National Survey of Substance Abuse Treatment Services (N-SSATS), the Medicaid Analytic eXtract (MAX) files, and the Treatment Episode Data Set TEDS. We consider the role of community environmental factors and state policies, how they might interact with individual and clinical factors to influene Buprenorphine access and utilization, and in what treatment settings such use occurs. Moreover, by considering office-based opioid agonist treatment as well as substance abuse treatment setting OAT, we can provide insights into factors that actually increase the total number of individuals receiving OAT, from factors that simply cause people to shift forms of treatment. Our findings will provide decision makers with critical information regarding state level regulations and community-level facilitators and barriers associated with increased utilization of OAT generally and Buprenorphine in particular.