Geisinger Commonwealth School of Medicine, Scranton, PA, USA.
University of New England, Portland, ME, USA.
Ann Pharmacother. 2022 Mar;56(3):271-279. doi: 10.1177/10600280211028262. Epub 2021 Jun 29.
Methadone is an evidence-based treatment for opioid use disorder (OUD) and pain management. Methadone for OUD may be difficult for some patients to access, particularly those in rural areas.
The purpose of this study was to characterize methadone distribution patterns between 2017 and 2019 across the United States.
The US Drug Enforcement Administration's Automated Reports and Consolidated Ordering System was used to acquire the number of opioid treatment programs (OTPs) per state and methadone distribution weight in grams. Methadone distributions by weight, corrected for state population and number of OTPs, were compared from 2017 to 2019 between states, within regions, and nationally.
The national distribution of methadone increased +12.3% for OTPs but decreased -34.6% for pain. Whereas all states saw a decrease in pain distribution, the Northeast showed a significantly smaller decrease than all other regions. Additionally, the majority of states experienced an increase in distribution for OTPs, and most states demonstrated a relatively stable or increasing number of OTPs, with an +11.5% increase nationally. The number of OTPs per 100K state population ranged from 2.1 in Rhode Island to 0.0 in Wyoming.
Although methadone distribution for OUD was increasing in the United States, the pronounced regional disparities identified warrant further consideration to improve patient access to this evidence-based pharmacotherapy, particularly in the Midwest and West regions. Greater implementation of telehealth and involvement of primary care into opioid treatment practice offer possible solutions to eliminating geographical treatment barriers.
美沙酮是一种治疗阿片类药物使用障碍（OUD）和疼痛管理的循证治疗方法。对于某些患者来说，美沙酮治疗 OUD 可能难以获得，尤其是在农村地区的患者。
本研究的目的是描述 2017 年至 2019 年美国美沙酮的分布模式。
使用美国毒品管制局的自动报告和综合订购系统获取每个州的阿片类药物治疗计划（OTP）数量和每克美沙酮分布量。对 2017 年至 2019 年各州之间、各地区内和全国范围内按重量计算的美沙酮分布进行比较，按州人口和 OTP 数量进行校正。
全国范围内 OTP 美沙酮分布增加了+12.3%，而疼痛则减少了-34.6%。尽管所有州的疼痛分布都有所减少，但东北地区的减少幅度明显小于其他地区。此外，大多数州的 OTP 分布增加，大多数州的 OTP 数量相对稳定或增加，全国范围内增加了+11.5%。每 10 万州人口的 OTP 数量从罗德岛的 2.1 个到怀俄明州的 0.0 个不等。
尽管美国 OUD 的美沙酮分布在增加，但所确定的明显区域差异需要进一步考虑，以改善患者获得这种循证药物治疗的机会，特别是在中西部和西部地区。更广泛地实施远程医疗和将初级保健纳入阿片类药物治疗实践中，可能是消除地理治疗障碍的解决方案。
