流动美沙酮药物治疗单位：简要历史、范围综述及研究机会。
Mobile methadone medication units: A brief history, scoping review and research opportunity.
机构信息
Department of General Internal Medicine, OHSU Medical School, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States of America.
OHSU-PSU School of Public Health, Oregon Health & Science University, CB669, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States of America.
出版信息
J Subst Abuse Treat. 2021 Oct;129:108483. doi: 10.1016/j.jsat.2021.108483. Epub 2021 May 16.
BACKGROUND
The Drug Enforcement Administration (DEA) approved the first mobile medication unit (i.e., a van to administer methadone) in 1988 and approved units on an ad hoc basis until issuing a moratorium in 2007 citing concerns about safety and diversion. In February 2020, the DEA released a notice of proposed rulemaking to permit a resumption of mobile medication units. The Biden Administration plans to release the final rule in 2021. Because a preliminary scan suggested limited evidence, a scoping review examined the research related to methadone vans to identify and assess the extent of mobile methadone research and inform the development and implementation of new mobile services.
METHODS
A scoping review, supplemented with key informant interviews, identified and described the most relevant evidence. Ovid MEDLINE and the Cochrane Database of Systematic Reviews databases were searched from inception to July 2020.
RESULTS
Informant interviews provided perspective on the need for and the use of mobile medication units, the history of methadone vans, and benefits and problems associated with the units. The scoping review found limited evidence: three cohort analyses (one prospective) and one before and after analysis (four studies) of individuals using mobile medication services. Mobile services were associated with enhanced retention in care (relative to patients in fixed site programs) and mobile units appeared to facilitate access for underserved populations with opioid use disorders.
DISCUSSION
The key informants addressed the history of methadone vans, the potential use to serve rural communities and correctional facilities and the benefits and problems associated with mobile services. The scoping review found evidence that mobile services increase methadone access among underserved populations and may enhance retention in care. The DEA's proposed regulatory modification creates opportunities to further evaluate the implementation and the effects of mobile medication units.
背景
美国缉毒署（DEA）于 1988 年批准了第一个移动药物管理单元（即一辆用于管理美沙酮的面包车），并根据需要临时批准了一些单元，直到 2007 年因安全和滥用问题而暂停。2020 年 2 月，DEA 发布了一份拟议规则制定通知，允许恢复移动药物管理单元。拜登政府计划在 2021 年发布最终规则。由于初步扫描显示证据有限，因此进行了范围审查，以检查与美沙酮面包车相关的研究，以确定和评估移动美沙酮研究的范围，并为新的移动服务的开发和实施提供信息。
方法
范围审查辅以关键知情人访谈，确定并描述了最相关的证据。从创建到 2020 年 7 月，在 Ovid MEDLINE 和 Cochrane 系统评价数据库中进行了搜索。
结果
知情人访谈提供了有关移动药物管理单元的需求和使用、美沙酮面包车的历史以及与这些单元相关的益处和问题的观点。范围审查发现证据有限：三项队列分析（一项前瞻性）和一项前后分析（四项研究）涉及使用移动药物服务的个体。移动服务与增强护理保留率相关（与固定站点计划中的患者相比），并且移动单元似乎为有阿片类药物使用障碍的服务不足人群提供了便利。
讨论
关键知情人讨论了美沙酮面包车的历史、为农村社区和惩教设施提供服务的潜在用途以及移动服务的好处和问题。范围审查发现，移动服务可以增加服务不足人群获得美沙酮的机会，并可能提高护理保留率。DEA 的拟议监管修改为进一步评估移动药物管理单元的实施和效果创造了机会。
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