WWAMI Rural Health Research Center, Department of Family Medicine, University of Washington School of Medicine, Seattle, Washington, USA.
J Rural Health. 2022 Jan;38(1):87-92. doi: 10.1111/jrh.12569. Epub 2021 Mar 18.
Buprenorphine is an effective medication treatment for opioid use disorder (MOUD) but access is difficult for patients, especially in rural locations. To improve access, legislation, including the Comprehensive Addiction and Recovery Act (2016) and the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act (2018), extended the ability to get a Drug Enforcement Administration (DEA) waiver to prescribe buprenorphine to treat opioid use disorder (OUD) to numerous types of clinicians. This study updates the distribution of waivered clinicians as of July 2020 and notes regional and geographic differences.
Using the July 2020 Drug Enforcement Administration list of providers with a waiver to prescribe buprenorphine to treat OUD, we assigned waivered clinicians to counties in one of four geographic categories. We calculated the number of counties in each category that did not have a waivered clinician, available treatment slots, and the county provider to population ratios.
The number of DEA-waivered clinicians more than doubled between December 2017 and July 2020 from 37,869 to 98,344. The availability of a clinician with a DEA waiver to provide MOUD has increased across all geographic categories. Nearly two-thirds of all rural counties (63.1%) had at least one clinician with a DEA waiver but more than half of small and remote rural counties lacked one. There were also significant differences in access by the US Census Division.
Overall, MOUD access has improved, but small rural communities still experience treatment disparities and there is significant regional variation.
丁丙诺啡是治疗阿片类药物使用障碍（MOUD）的有效药物治疗方法，但患者，尤其是农村地区的患者很难获得这种药物。为了改善这种情况，立法，包括《综合成瘾和康复法案》（2016 年）和《促进阿片类药物康复和治疗患者及社区的物质使用障碍预防法案》（2018 年），扩大了获得药物管制局（DEA）豁免权以开处丁丙诺啡治疗阿片类药物使用障碍（OUD）的能力，让许多类型的临床医生都能获得豁免权。本研究更新了截至 2020 年 7 月的豁免临床医生的分布情况，并注意到了地区和地理差异。
使用 2020 年 7 月药物管制局提供的拥有丁丙诺啡处方豁免权的提供者名单，我们将豁免临床医生分配到四个地理类别之一的县。我们计算了每个类别中没有豁免临床医生的县的数量、可用的治疗名额以及县内临床医生与人口的比例。
自 2017 年 12 月至 2020 年 7 月，DEA 豁免临床医生的数量从 37869 人增加到 98344 人，增加了一倍多。所有地理类别都增加了获得 DEA 豁免以提供 MOUD 的临床医生数量。近三分之二的农村县（63.1%）至少有一名拥有 DEA 豁免的临床医生，但超过一半的小而偏远的农村县没有。美国人口普查分区的获得情况也存在显著差异。
总体而言，MOUD 的获得情况有所改善，但小农村社区仍存在治疗差距，地区差异显著。
