Division of General Internal Medicine, Department of Medicine, University of Colorado, Aurora, CO, USA.
British Columbia Centre on Substance Use, University of British Columbia, Vancouver, Canada.
J Gen Intern Med. 2019 Jun;34(6):1039-1042. doi: 10.1007/s11606-018-4801-3. Epub 2019 Feb 6.
In the midst of an opioid epidemic, mortality related to opioid overdose continues to rise in the US. Medications to treat opioid use disorder, including methadone and buprenorphine, are highly effective in reducing the morbidity and mortality related to illicit opioid use. Despite the efficacy of these life-saving medications, the majority of people with an opioid use disorder lack access to treatment. This paper briefly reviews the evidence to support the use of medications to treat opioid use disorder with a specific focus on methadone. We discuss the current state of methadone therapy for the treatment of opioid use disorder in the US and present logistical barriers that limit its use. Next, we examine three international pharmacy-based models in which methadone dispensing to treat opioid use disorder occurs outside of an opioid treatment facility. We discuss current challenges and opportunities to incorporate similar methods of methadone dispensing for the treatment of opioid use disorder in the US. Finally, we present our vision to integrate pharmacy-based methadone dispensing into routine opioid use disorder treatment through collaboration between clinicians and pharmacies to improve local access to this life-saving medication.
在美国阿片类药物流行期间，与阿片类药物过量相关的死亡率持续上升。治疗阿片类药物使用障碍的药物，包括美沙酮和丁丙诺啡，在降低与非法阿片类药物使用相关的发病率和死亡率方面非常有效。尽管这些挽救生命的药物具有疗效，但大多数阿片类药物使用障碍患者都无法获得治疗。本文简要回顾了支持使用药物治疗阿片类药物使用障碍的证据，特别关注美沙酮。我们讨论了美国目前治疗阿片类药物使用障碍的美沙酮疗法的现状，并介绍了限制其使用的实际障碍。接下来，我们研究了三种基于国际药房的模式，其中在阿片类药物治疗机构之外提供美沙酮以治疗阿片类药物使用障碍。我们讨论了在将类似的美沙酮配药方法纳入美国阿片类药物使用障碍治疗方面当前面临的挑战和机遇。最后，我们提出了通过临床医生和药房之间的合作，将基于药房的美沙酮配药纳入常规阿片类药物使用障碍治疗的设想，以改善当地获得这种救命药物的机会。
