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Int J Drug Policy. 2019 Nov;73:42-48. doi: 10.1016/j.drugpo.2019.07.006. Epub 2019 Jul 20.
The United States continues to face a public health crisis of opioid-related harm, the effects of which could be dramatically reduced through increased access to opioid agonist therapy with the medications methadone and buprenorphine. Despite overwhelming evidence of their efficacy, unduly restrictive federal, state, and local regulation significantly impedes access to these life-saving medications. We outline immediate, concrete steps that federal, state, and local governments can take to change law from barrier to facilitator of evidence-based treatment for opioid use disorder. These include removing onerous restrictions on the prescription and dispensing of buprenorphine and methadone for opioid agonist therapy, requiring insurance coverage of these medications, and mandating that they be provided in correctional settings and promoted by drug courts. Finally, we argue that jurisdictions should proactively offer opioid agonist therapy to individuals at high risk of overdose, remove barriers to establishing methadone treatment facilities, and address underlying social determinants and barriers to treatment. These changes have the ability to save thousands of lives annually.
美国持续面临阿片类药物相关伤害的公共卫生危机，而通过增加美沙酮和丁丙诺啡等阿片类激动剂治疗的可及性，这些影响可以得到显著减轻。尽管有压倒性的证据表明这些药物的疗效，但联邦、州和地方法律规定过度限制，严重阻碍了这些救命药物的可及性。我们概述了联邦、州和地方政府可以采取的立即采取的具体步骤，将法律从阿片类药物使用障碍的基于证据的治疗的障碍转变为促进因素。这些措施包括取消对阿片类激动剂治疗中丁丙诺啡和美沙酮处方和配药的繁琐限制，要求这些药物纳入医疗保险范围，并规定在惩教场所提供这些药物，并由毒品法庭推广。最后，我们认为，各辖区应主动向有过量风险的个人提供阿片类激动剂治疗，消除建立美沙酮治疗设施的障碍，并解决潜在的社会决定因素和治疗障碍。这些变化有能力每年挽救数千条生命。
