Increasing access to medication-assisted treatment: Interactions between federal and state workforce policies

摘要/项目总结 阿片类药物使用障碍的药物治疗是努力减少高社会风险的重要组成部分。 处方和非处方阿片类药物滥用的成本和死亡率。这种方法包括 药物疗法（例如，丁丙诺啡、美沙酮、纳洛酮）作为阿片类药物依赖治疗的一部分。 丁丙诺啡的有效性已在许多研究中得到证实，可以在办公室处方 环境;因此，丁丙诺啡对于扩大药物治疗的可及性特别重要 阿片类药物使用障碍然而，对治疗的需求大大超过了授权提供者的数量 尤其是在农村地区，供应商的短缺尤为严重。美国许多县没有 单一供应商。 为了应对丁丙诺啡处方药短缺的问题，2004年制定了两项联邦劳动力政策。 2016年：（1）允许执业护士和医生助理获得授权开丁丙诺啡 在办公室为基础的设置，和（2）增加最大数量的病人，可以规定 丁丙诺啡从100升到275 2018年通过的立法允许其他高级执业护士 （护士助产士，临床护理专家和护士麻醉师）也可以开丁丙诺啡。这些 预计这些政策将增加数千名阿片类药物使用障碍患者获得药物治疗的机会， 个体然而，这些政策实现其目标的程度将取决于其他环境因素。 和政策因素，最重要的是国家法律，规范先进的实践临床医生的药物处方。 拟议的研究将评估这些劳动力政策对供应和地理范围的影响 阿片类药物治疗提供者，重点是国家政策是否以及如何促进或阻碍增长， 可用的开处方者。具体目标是： 目标1：衡量2016年和2018年制定的联邦政策对人口数量和 豁免丁丙诺啡的临床医生的地理分布。 目标2：确定州一级的执业范围法规是否持续调节有效性 联邦政策旨在增加丁丙诺啡治疗的可及性。 目标3：评估是否扩大授权开处方的临床医生的数量和类型 丁丙诺啡与丁丙诺啡的更大分配相关。 将使用计量经济学方法分析2016年至2022年的多个来源的数据， 解决可能影响丁丙诺啡处方者增长和使用的法规的州差异 同时控制可能影响政策执行的其他法规和计划。时发现的问题 研究可用于促进协调州和联邦解决阿片类药物危机的努力 在美国和受影响严重的地区。

ABSTRACT / PROJECT SUMMARY Medication treatment for opioid use disorder is an important component of efforts to reduce the high social costs of prescription and non-prescription opioid abuse and mortality. This approach incorporates pharmacotherapies (e.g., buprenorphine, methadone, naltrexone) as part of treatment for opioid dependence. Buprenorphine’s effectiveness has been established in numerous studies and can be prescribed in office-based settings; thus, buprenorphine is particularly important to the expansion of access to medication treatment for opioid use disorder. However, the need for treatment dramatically outstrips the number of providers authorized to prescribe it, with particularly severe shortages of providers in rural areas. Many U.S. counties do not have a single provider. In response to the shortage of buprenorphine prescribers, two federal workforce policies were established in 2016: (1) allowing nurse practitioners and physician assistants to become authorized to prescribe buprenorphine in office-based settings, and (2) increasing the maximum number of patients that can be prescribed buprenorphine by a physician from 100 to 275. Legislation passed in 2018 allows other advanced practice nurses (nurse-midwives, clinical nurse specialists, and nurse-anesthetists) to prescribe buprenorphine as well. These policies are expected to increase access to medication treatment for opioid use disorder for thousands of individuals. However, the degree to which these policies achieve their goal will depend on other environmental and policy factors, most importantly state laws that regulate advanced practice clinicians’ medication prescribing. The proposed study will assess the impacts of these workforce policies on the supply and geographic reach of opioid treatment providers, with a focus on whether and how state policies facilitate or impede growth in available prescribers. The specific aims are: Aim 1: To measure the degree to which federal policies established in 2016 and 2018 impact the number and geographic distribution of clinicians with buprenorphine waivers. Aim 2: To determine whether state-level scope of practice regulations persistently moderate the effectiveness of federal policies aimed at increasing access to buprenorphine treatment. Aim 3: To assess whether expansions of the number and types of clinicians authorized to prescribe buprenorphine are associated with greater dispensing of buprenorphine. Data from multiple sources from 2016 through 2022 will be analyzed using econometric approaches that address state variation in regulations that may affect the growth of buprenorphine prescribers and utilization while controlling for other regulations and programs that might affect policy implementation. Findings from this research could be used to promote the harmonization of state and federal efforts to address the opioid crisis across the U.S. and in highly-impacted regions.