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

美国阿片类药物过量死亡的流行已经持续了20多年。非大都市或农村地区， 阿片类药物使用障碍（OUD）治疗能力低与阿片类药物使用率显著升高相关 过量死亡许多国家增加了OUD治疗的可及性，通过允许 社区药房分发美沙酮用于美沙酮维持治疗。MMT已经 研究最多和使用时间最长的OUD治疗约55年以上。联邦法规要求MMT 通过约1，860个SAMHSA认证的阿片类药物治疗计划（OTP）之一提供。现代货币理论 被认为更便宜（更负担得起），治疗保留率高于丁丙诺啡 治疗OUD。因此，MMT是许多OUD患者的首选治疗选择。 然而，由于被占领土的数量有限，现有OTP的能力有限，以及到OTP的旅行距离较长， 是获得MMT的主要障碍，特别是对于农村和郊区的OUD患者。药剂师 是最值得信赖的医疗保健专业人士之一。大约90%的美国人住在离社区5英里的范围内。 去的.联邦法规允许OTP获得批准建立美沙酮药物单位（MU） 在药房（药房MU），允许药房管理和分发美沙酮的MMT， 扩大治疗。MU由上级OTP的OTP主管管理，他们负责监督患者护理， 主OTP和MU位置。MU在美国很少使用。鉴于严重短缺 为了解决不断升级的阿片类药物过量死亡流行病，迫切需要 确定建立多边机构的有用战略，并传播建立多边机构的有用战略 在全国范围内向美国的OTP董事和社区药剂师提供。 在借鉴了主要研究者（吴博士）关于医生-社区药师培养研究的成功经验的基础上， 协作护理模式，使社区药剂师参与提供丁丙诺啡治疗护理， OUD患者（Wu等人，2021 a）和美沙酮用于MMT的给药和分配（Wu等， 2021 b），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 对每次调查的参与者进行定性访谈，以进一步获得关于MU的深入数据 美国的实施障碍和促进因素。 由于OUD提供者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。 这项研究将是在美国的第一次努力，以确定MU实施的障碍和促进者从OTP 董事和药剂师。我们将制作多个同行评审的出版物和一个电子工具包， * 设立谅解备忘录，以便迅速向检察官办公室主任和药剂师分发工具包和出版物。

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.