Oregon Health Authority, State Opioid Treatment Authority, Salem, OR (JWM), OHSU-PSU School of Public Health, Oregon Health and Science University, Portland, OR (KH, DC, DM), MD/PhD Program, School of Medicine, Oregon Health and Science University, Portland, OR (KCP), Division of General Internal Medicine, School of Medicine, Section of Addiction Medicine, Oregon Health and Science University, Portland, OR (PTK).
J Addict Med. 2021;15(6):516-518. doi: 10.1097/ADM.0000000000000812.
To slow the spread of SARS-CoV-2 in opioid treatment programs (OTPs), SAMHSA notified State Opioid Treatment Authorities that stable patients could receive up to 27 days of take-homes, less stable patients could receive up to 13 days with fewer take-homes for other patients. An analysis assessed how the relaxed standards affected the number of patient dosing visits and the amount of take-home medications dispensed in Oregon's 20 public, nonprofit, and for-profit OTPs. OTPs reported the number of patients receiving take homes pre and post federal policy change at 3 time points: pre SARS-CoV-2 (February or first half of March), post 1 SARS-CoV-2 (March, April, or May), and post 2 SARS-CoV-2 (April, May, or June). The patients receiving each quantity of take-homes were counted and means calculated for visits and take-homes per patient per month. A negative binomial mixed-effects regression model assessed change in mean dosing visits per patient. During the pre SARS-CoV-2 period, OTPs served 7792 patients monthly with 120,513 medication visits and dispensed 44,883 take-home doses. Mean patient visits per month were 15.5 with 5.8 take-homes per patient per month. Following the policy change, medication visits declined 33% and take-home medication increased 97% with 10.4 mean visits per patient and 11.3 mean take-homes per patient. The negative binomial mixed-effects regression model estimated a 54% reduction in mean visits per patient. The policy change had the intended effect. More research is needed to assess unintended consequences associated with increased access to take-home medication.
为了减缓 SARS-CoV-2 在阿片类药物治疗计划 (OTP) 中的传播,SAMHSA 通知州阿片类药物治疗管理局,稳定的患者可以获得长达 27 天的带药回家,不太稳定的患者可以获得长达 13 天的带药回家,但其他患者的带药回家次数较少。一项分析评估了放宽标准如何影响俄勒冈州 20 家公立、非营利和营利性 OTP 中患者的给药就诊次数和带药回家的药物数量。OTP 在联邦政策变更前后的三个时间点报告了接受带药回家的患者人数:SARS-CoV-2 之前(2 月或 3 月上半月)、SARS-CoV-2 之后 1 次(3 月、4 月或 5 月)和 SARS-CoV-2 之后 2 次(4 月、5 月或 6 月)。计算了每个带药回家数量的患者人数,并计算了每个患者每月的就诊和带药回家次数的平均值。采用负二项混合效应回归模型评估了每位患者平均给药就诊次数的变化。在 SARS-CoV-2 之前的时期,OTP 每月为 7792 名患者提供服务,有 120513 次药物就诊和 44883 次带药回家。每月平均就诊人数为 15.5 次,每位患者每月带药回家 5.8 次。政策变更后,药物就诊次数下降了 33%,带药回家药物增加了 97%,每位患者的平均就诊次数为 10.4 次,平均带药回家次数为 11.3 次。负二项混合效应回归模型估计每位患者的就诊次数减少了 54%。政策变更达到了预期效果。需要进一步研究来评估增加带药回家药物可及性相关的意外后果。