RTI International, Berkeley, CA, United States; University of California San Francisco, San Francisco, CA, United States; University of Washington, Seattle, WA, United States.
University of Southern California, Los Angeles, CA, United States.
Drug Alcohol Depend. 2022 Aug 1;237:109504. doi: 10.1016/j.drugalcdep.2022.109504. Epub 2022 May 20.
Among people with an opioid use disorder in the United States, only 10% receive buprenorphine treatment. The Ryan Haight Act is a federal law that has regulated buprenorphine delivery, requiring an in-person examination between a patient and provider before initiating treatment. At the beginning of the COVID-19 pandemic, federal agencies waived in-person examination requirements for buprenorphine treatment initiation. We examined whether Ryan Haight Act waiver improved implementation of telehealth buprenorphine within syringe service programs (SSPs) - organizations that serve people with historically low access to treatment.
We surveyed all known SSPs operating in the US in 2021 (N = 421) of which 77% responded (n = 325). We calculated the prevalence and accompanying 95% confidence intervals (CI) for implementation of telehealth buprenorphine inductions at SSPs in 2020. Multivariable logistic regression was used to assess differences in implementing telehealth buprenorphine inductions by organizational characteristics.
In 2020, the prevalence of implementing buprenorphine inductions via telehealth was 24% (95% CI:19-30%). Non-governmental SSPs had a higher odds of telehealth buprenorphine inductions (adjusted odds ratio (aOR)= 2.92; 95% CI:1.22-7.00; p = 0.016), compared to governmental SSPs. Furthermore, the larger the organization's annual budget, the higher the odds of telehealth buprenorphine implementation (aOR=2.00 per quartile (95% CI:1.33-2.99; p = 0.001). SSPs located in states with higher opioid overdose mortality rates did not have significantly higher likelihood of telehealth buprenorphine implementation.
A substantial number of SSPs implemented telehealth buprenorphine after waiver of the Ryan Haight Act. Permanent adoption of this waiver will be critical and providing financial resources to SSPs is vital to support implementation of new innovations.
在美国，患有阿片类药物使用障碍的人群中，仅有 10%接受丁丙诺啡治疗。《瑞安·海特法案》是一项规范丁丙诺啡交付的联邦法律，要求在开始治疗前，患者和提供者之间进行面对面检查。在 COVID-19 大流行开始时，联邦机构免除了丁丙诺啡治疗开始时的当面检查要求。我们研究了《瑞安·海特法案》豁免是否改善了在注射器服务项目（SSP）中实施远程医疗丁丙诺啡的情况，SSP 是为治疗机会历来较低的人群提供服务的组织。
我们调查了 2021 年在美国运营的所有已知 SSP（N=421），其中 77%（n=325）做出回应。我们计算了 2020 年 SSP 实施远程医疗丁丙诺啡诱导的流行率和相应的 95%置信区间（CI）。使用多变量逻辑回归评估组织特征对实施远程医疗丁丙诺啡诱导的差异。
2020 年，通过远程医疗实施丁丙诺啡诱导的流行率为 24%（95%CI：19-30%）。与政府 SSP 相比，非政府 SSP 进行远程医疗丁丙诺啡诱导的可能性更高（调整后的优势比（aOR）=2.92；95%CI：1.22-7.00；p=0.016）。此外，组织的年度预算越大，实施远程医疗丁丙诺啡的可能性就越高（aOR=每四分位（95%CI：1.33-2.99；p=0.001）增加 2.00）。位于阿片类药物过量死亡率较高的州的 SSP 并没有显著更高的远程医疗丁丙诺啡实施可能性。
大量 SSP 在《瑞安·海特法案》豁免后实施了远程医疗丁丙诺啡。永久采用这项豁免将是至关重要的，为 SSP 提供财政资源对于支持新创新的实施至关重要。
