Johns Hopkins School of Medicine, Division of Adolescent/Young Adult Medicine, Department of Pediatrics, 200 North Wolfe Street, Baltimore, MD 21287, United States of America; Johns Hopkins Bloomberg School of Public Health, Department of Population, Family, and Reproductive Health, 615 N Wolfe Street, Baltimore, MD 21205, United States of America.
Johns Hopkins School of Medicine, Division of Adolescent/Young Adult Medicine, Department of Pediatrics, 200 North Wolfe Street, Baltimore, MD 21287, United States of America.
J Subst Abuse Treat. 2022 Oct;141:108803. doi: 10.1016/j.jsat.2022.108803. Epub 2022 May 17.
Initiating medication for opioid use disorder (MOUD) during emergency department (ED) visits is an important innovation to engage individuals in addiction treatment. In 2018, Massachusetts passed the CARE Act, becoming the first state to legislate that hospitals with EDs must be able to offer MOUD. We performed a qualitative study to explore factors influencing policy enactment.
Semi-structured interviews were conducted in 2019 with ten key stakeholders involved in the policymaking process representing state government, hospitals, physician professional societies, and recovery/behavioral health organizations. Data were analyzed in 2020-2021 using a hybrid inductive-deductive approach.
The first key theme stakeholders expressed was the importance of research and public health consensus; they described consensus building within existing coalitions regarding the pressing need for action, and supporting expansion of treatment with this evidence-based strategy. Second, stakeholders discussed overcoming financing and feasibility concerns by passing budget-neutral legislation and ensuring flexibility for diverse hospital types. Lastly, stakeholders looked towards implementation, describing the implementation guide development process and ensuring capacity for continuing treatment existed throughout the state.
This study suggests that research supporting the effectiveness of ED MOUD induction drove the passage of this state legislation. Long-term collaboration between diverse stakeholders towards a common goal of increasing access to evidence-based treatment to address the opioid epidemic was also perceived as facilitating the law's passage. Policymakers and advocates in other states may look towards Massachusetts's legislative process as a model for implementing similar legislation as part of their strategies to address the drug overdose crisis.
在急诊部 (ED) 就诊时开始使用阿片类药物使用障碍 (MOUD) 的药物治疗是让个人参与成瘾治疗的一项重要创新。2018 年，马萨诸塞州通过了 CARE 法案，成为第一个立法规定必须能够在拥有 ED 的医院提供 MOUD 的州。我们进行了一项定性研究，以探讨影响政策实施的因素。
2019 年，我们对参与决策过程的十位关键利益相关者进行了半结构化访谈，这些利益相关者代表州政府、医院、医生专业协会和康复/行为健康组织。2020-2021 年，我们使用混合归纳演绎方法对数据进行了分析。
利益相关者首先表达的一个关键主题是研究和公共卫生共识的重要性；他们描述了在现有联盟内就采取行动的紧迫需求达成共识，并支持通过这种基于证据的策略扩大治疗范围。其次，利益相关者讨论了通过无预算影响的立法和确保不同类型医院的灵活性来克服融资和可行性问题。最后，利益相关者着眼于实施，描述了实施指南的制定过程，并确保全州都有继续治疗的能力。
这项研究表明，支持 ED MOUD 诱导有效性的研究推动了该州立法的通过。不同利益相关者之间为增加获得基于证据的治疗以解决阿片类药物流行而长期合作，也被认为有助于该法律的通过。其他州的政策制定者和倡导者可能会将马萨诸塞州的立法过程视为实施类似立法的模式，作为解决药物过量危机战略的一部分。
