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通过针具交换项目中的远程医疗改善丁丙诺啡治疗的公平性和可及性。

Improving equity and access to buprenorphine treatment through telemedicine at syringe services programs.

机构信息

RTI International, 2150 Shattuck Avenue, Suite 800, Berkeley, CA, 94704, USA.

Bright Heart Health, Walnut Creek, CA, USA.

出版信息

Subst Abuse Treat Prev Policy. 2022 Jul 15;17(1):51. doi: 10.1186/s13011-022-00483-1.


DOI:10.1186/s13011-022-00483-1
PMID:35841036
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9283820/
Abstract

BACKGROUND AND AIMS: In the United States, access to buprenorphine remains low and disparities regarding who receives treatment have emerged. Federal laws have regulated buprenorphine delivery, ultimately limiting its implementation more broadly. At the onset of the COVID-19 pandemic, federal agencies acted quickly to remove a legal barrier, effectively allowing people with opioid used disorder (OUD) to initiate buprenorphine treatment via telemedicine. Leveraging this policy shift, a low barrier buprenorphine treatment initiative via telemedicine was started at syringe service programs in California. We assessed early findings from participants reached by this model of treatment. METHODS: In May 2020, buprenorphine treatment was offered through a virtual platform to SSP participants in California. SSP staff connected interested participants to virtual appointments with medical providers in a private location. During these visits, clinicians conducted clinical assessments for diagnosing participants with OUD and developed an unsupervised home induction plan for individuals who were eligible. Participants were prescribed a 7-day supply of up to 16 mg daily buprenorphine or 16 mg buprenorphine-2 mg naloxone and asked to return the following week if interested in continuing treatment. RESULTS: From May 2020 to March 2021, the SSP-buprenorphine virtual care initiative inducted 115 participants onto treatment with 87% of participants inducted on the same day as their referral. Of those inducted, 58% were between the ages of 30 and 49 and 28% were cisgender female. Regarding participants' method of payment to reimburse buprenorphine costs, 92% of participants were covered by Medicare/Medicaid. Overall, 64% of participants returned for a second buprenorphine prescription refill. CONCLUSIONS: These early findings suggest that this could be a promising approach to improve equity and access to buprenorphine treatment. We encourage policymakers to continue allowing buprenorphine delivery via telemedicine and researchers to study whether this approach improves equity and access to treatment throughout the United States.

摘要

背景与目的:在美国,阿片类药物使用障碍(OUD)患者获得丁丙诺啡的机会仍然很低,并且在接受治疗的人群方面存在差异。联邦法律对丁丙诺啡的使用进行了监管,最终更广泛地限制了其实施。在 COVID-19 大流行开始时,联邦机构迅速采取行动消除了一个法律障碍,有效地允许 OUD 患者通过远程医疗启动丁丙诺啡治疗。利用这一政策转变,加利福尼亚州的注射器服务项目启动了一项通过远程医疗提供低门槛丁丙诺啡治疗的倡议。我们评估了通过这种治疗模式接触到的参与者的早期发现。

方法:2020 年 5 月,通过虚拟平台向加利福尼亚州的 SSP 参与者提供丁丙诺啡治疗。SSP 工作人员将有兴趣的参与者与私人地点的医疗提供者进行虚拟预约联系起来。在这些访问中,临床医生对参与者进行了 OUD 诊断的临床评估,并为符合条件的个人制定了非监督家庭诱导计划。参与者被开处 7 天剂量的丁丙诺啡,最高剂量为每天 16 毫克或丁丙诺啡 16 毫克-纳洛酮 2 毫克,并被要求在感兴趣继续治疗的情况下,在下周返回。

结果:从 2020 年 5 月到 2021 年 3 月,SSP-丁丙诺啡虚拟护理倡议共为 115 名参与者进行了治疗,其中 87%的参与者在转诊当天接受了治疗。在这些参与者中,58%的年龄在 30 到 49 岁之间,28%是跨性别女性。关于参与者支付丁丙诺啡费用的方式,92%的参与者由医疗保险/医疗补助覆盖。总体而言,64%的参与者返回领取第二份丁丙诺啡处方续药。

结论:这些早期发现表明,这可能是一种改善丁丙诺啡治疗可及性和公平性的有前途的方法。我们鼓励政策制定者继续允许通过远程医疗提供丁丙诺啡,并鼓励研究人员研究这种方法是否可以提高整个美国的公平性和治疗可及性。

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本文引用的文献

[1]
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Drug Alcohol Depend. 2022-1-1

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Harm Reduct J. 2021-7-30

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JAMA Psychiatry. 2019-9-1

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Addict Sci Clin Pract. 2019-5-6

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