1242 Field Services Branch, Division of State and Local Readiness, Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA.
1496 Office of Preparedness and Response, Public Health Services, Maryland Department of Health, Baltimore, MD, USA.
Public Health Rep. 2021 Nov-Dec;136(1_suppl):9S-17S. doi: 10.1177/00333549211046110.
Federal and state enforcement authorities have increasingly intervened on the criminal overprescribing of opioids. However, little is known about the health effects these enforcement actions have on patients experiencing disrupted access to prescription opioids or medication-assisted treatment/medication for opioid use disorder. Simultaneously, opioid death rates have increased. In response, the Maryland Department of Health (MDH) has worked to coordinate mitigation strategies with enforcement partners (defined as any federal, state, or local enforcement authority or other governmental investigative authority). One strategy is a standardized protocol to implement emergency response functions, including rapidly identifying health hazards with real-time data access, deploying resources locally, and providing credible messages to partners and the public. From January 2018 through October 2019, MDH used the protocol in response to 12 enforcement actions targeting 34 medical professionals. A total of 9624 patients received Schedule II-V controlled substance prescriptions from affected prescribers under investigation in the 6 months before the respective enforcement action; 9270 (96%) patients were residents of Maryland. Preliminary data indicate fatal overdose events and potential loss of follow-up care among the patient population experiencing disrupted health care as a result of an enforcement action. The success of the strategy hinged on endorsement by leadership; the establishment of federal, state, and local roles and responsibilities; and data sharing. MDH's approach, data sources, and lessons learned may support health departments across the country that are interested in conducting similar activities on the front lines of the opioid crisis.
联邦和州执法部门越来越多地干预阿片类药物的过度处方犯罪行为。然而，对于这些执法行动对经历处方阿片类药物或药物辅助治疗/阿片类药物使用障碍药物获取中断的患者的健康影响知之甚少。与此同时，阿片类药物死亡率上升。作为回应，马里兰州卫生署（MDH）与执法伙伴（定义为任何联邦、州或地方执法当局或其他政府调查当局）合作协调缓解策略。一项策略是实施应急响应功能的标准化协议，包括通过实时数据访问快速识别健康危害、在当地部署资源以及向合作伙伴和公众提供可靠信息。从 2018 年 1 月到 2019 年 10 月，MDH 在 12 次针对 34 名医疗专业人员的执法行动中使用了该协议。在各自的执法行动之前的 6 个月内，共有 9624 名患者从受调查的开处受管制物质 II-V 类处方的医生那里获得了受管制物质 II-V 类处方；9270 名（96%）患者是马里兰州居民。初步数据表明，在因执法行动而导致医疗保健中断的患者群体中，出现了致命的过量用药事件和潜在的随访护理缺失。该策略的成功取决于领导层的认可；建立联邦、州和地方的角色和责任；以及数据共享。MDH 的方法、数据源和经验教训可能为有兴趣在阿片类药物危机的前线开展类似活动的全国卫生部门提供支持。
