Department of Behavioral Science, University of Kentucky, Lexington, Kentucky, USA.
Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky, USA.
Subst Abus. 2020;41(2):259-268. doi: 10.1080/08897077.2019.1635959. Epub 2019 Jul 11.
Increasing access to buprenorphine treatment is a critical tool for addressing the opioid epidemic in the United States. In 2016, a federal policy change allowed physicians who meet specific requirements to treat up to 275 concurrent buprenorphine patients. This study examines state-level measures of buprenorphine treatment supply over 21 months since this policy change and estimates associations between the supply of 275-patient waivers and state characteristics. Monthly state-level measures of the number of physicians holding the 275-patient waiver per 100,000 residents were constructed from September 2016 to May 2018 using the Drug Enforcement Agency's Controlled Substance Act database. State characteristics were obtained from publicly available sources. Mixed-effects regression models were estimated to examine change over time. During the 21-month period, the number of physicians waivered to treat 275 patients increased from 153 to 4009 physicians. The mean supply of 275-patient physicians per 100,000 state residents significantly increased from 0.07 (SD = 0.21) in September 2016 to 1.43 (SD = 1.08) in May 2018 ( = -9.84, = 50, < .001). The final mixed-effects regression model indicated that Census division and the preexisting supply of 100-patient waivered physicians were correlated with the rate of growth in 275-patient waivers over the study period. Although uptake of the 275-patient waiver has exceeded initial projections, growth is uneven across the United States. Unequal patterns of growth pose a challenge to efforts to increase treatment availability as a means of addressing the opioid epidemic.
增加丁丙诺啡治疗的可及性是解决美国阿片类药物流行的关键手段。2016 年，一项联邦政策的改变允许符合特定要求的医生为多达 275 名同时接受丁丙诺啡治疗的患者提供治疗。本研究考察了自政策改变以来的 21 个月内各州丁丙诺啡治疗供应情况，并估计了 275 名患者豁免供应与州特征之间的关联。从 2016 年 9 月至 2018 年 5 月，使用缉毒署的《管制物质法》数据库，构建了每 10 万名居民中持有 275 名患者豁免权的医生数量的月度州级指标。州特征数据来自公开来源。采用混合效应回归模型来检验随时间的变化。在 21 个月的时间里，获准治疗 275 名患者的医生人数从 153 人增加到 4009 人。每 10 万名州居民中 275 名患者豁免医生的平均供应量从 2016 年 9 月的 0.07（SD=0.21）显著增加到 2018 年 5 月的 1.43（SD=1.08）（ =−9.84， =50， < .001）。最终的混合效应回归模型表明，人口普查分区和 100 名患者豁免医生的现有供应与研究期间 275 名患者豁免的增长率相关。尽管 275 名患者豁免的使用率超过了最初的预测，但美国各地的增长情况并不均衡。增长模式的不平等给增加治疗可及性作为解决阿片类药物流行的手段带来了挑战。
