Liberating methadone: Building a roadmap and community for change

项目摘要/摘要 随着我们继续面临美国历史上最严重的吸毒过量流行病，迫切需要改变政策 扩大循证治疗渠道，防止服药过量死亡。美沙酮维持 治疗(MMT)在治疗阿片使用障碍(OUD)方面非常有效，并将过量用药的风险降低了50%以上。 然而，MMT在美国的利用率仍然很低。自20世纪70年代以来，MMT在美国的OUD只能是 通过高度结构化的阿片类药物治疗计划(OTP)的日常配药获得。刚硬 有关OTPS的法规极大地限制了它们的可用性，并使治疗体验 给病人带来极大的负担和耻辱。几十年来，这个系统一直被描述为一种 “液体手铐”，它降低了现有患者的地位，阻止了新患者进行治疗。 这是50年来的第一次，我们正处于一个可能改变MMT交付进程的历史性时刻 美国：联邦政策变化以缓解新冠肺炎风险，包括增加带回家的灵活性 美沙酮剂量，引发了关于MMT必要改革的讨论，包括扩大美沙酮 给药房配药。然而，为了指导这种改革，并告知一个更公平和更容易获得的乌德 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主办一次为期1.5天的会议 2023年7月在纽约发表题为《解放美沙酮：为变革建立路线图和社区》。 这次会议将提供一个独特和及时的机会，将主要合作伙伴聚集在一起--包括 研究人员、临床医生、政策制定者和药物使用者-讨论过去、现在和未来 OUD的MMT。这种面对面/虚拟混合会议将激励创新研究并建立凝聚力 跨多个小组，为更具包容性的研究协作和政策改革铺平道路 满足受过量用药危机影响最大的人群的需求。通过研究演示、小组讨论 讨论、政策工作组和会议会议将：(1)讨论以下方面的第一手经验 患者在目前的OTP系统中需要一个更易接近、更公平和以人为中心的 治疗系统；(2)为不同领域的创新研究和新的合作创造机会 合作伙伴通过审查关于当前美国MMT系统的现有证据和知识差距 和替代美沙酮给药模式；以及(3)起草和传播研究、实践和政策 建议推进将MMT扩展到OTP系统之外所需的改革。会议将于 支持NIDA优先研究领域应用科学推动政策，培育真正的社区- 通过将来自不同地区、种族和地区的广泛利益相关者聚集在一起进行研究 种族背景和生活经历，最重要的是，促进创新以改善准入 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.