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为变革而生的一代:为本科生医学教育中的阿片类药物使用障碍药物去监管化做准备。

A Generation Ready for Change: Preparing for the Deregulation of Medications for Opioid Use Disorder in Undergraduate Medical Education.

机构信息

S. Demuynck is a resident physician, Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.

出版信息

Acad Med. 2023 Apr 1;98(4):440-443. doi: 10.1097/ACM.0000000000004999. Epub 2022 Sep 27.

Abstract

The U.S. Department of Health and Human Services recently released updated guidance that allows providers under standard licensure to treat 30 or fewer patients with buprenorphine, a partial opioid agonist shown to be safe and effective as an office-based treatment for opioid use disorder (OUD). Previously, physicians and advanced practice providers needed to complete specialized training and certification under the Drug Addiction Treatment Act (DATA) of 2000 before prescribing medications for OUD (MOUD). This deregulatory action comes as rates of opioid-involved overdose have accelerated during the COVID-19 pandemic. Given the limited success of stepwise efforts to legislate for expanded access to MOUD, providers, professional associations, and other advocates have called for the elimination of the DATA requirements for all practitioners. An understanding of the statutory and regulatory history of MOUD may prove critical as legislative and policy actions continue to reshape clinical practice. Incorporating MOUD training as a standard in undergraduate medical education represents a unique opportunity for the medical community to prepare trainees for future deregulation of MOUD. Indeed, medical schools already offering or requiring MOUD training have demonstrated success in improving MOUD knowledge, skills, and attitudes among medical students and graduates. Existing virtual and hybrid training tools designed to meet DATA standards represent an accessible means to ensure critical learning for future generations of physicians uniquely ready and willing and to provide quality, evidence-based care to patients with OUD.

摘要

美国卫生与公众服务部最近发布了更新的指南,允许标准许可下的提供者为 30 名或更少的患者使用丁丙诺啡进行治疗,丁丙诺啡是一种部分阿片类激动剂,已被证明作为阿片类药物使用障碍(OUD)的门诊治疗是安全有效的。此前,医生和高级执业医师需要根据 2000 年《药物滥用治疗法》(DATA)完成专门的培训和认证,才能为 OUD(MOUD)开处方。这一放宽监管的措施是在 COVID-19 大流行期间,阿片类药物过量的发生率加速上升的情况下出台的。鉴于逐步立法扩大 MOUD 可及性的努力收效有限,提供者、专业协会和其他倡导者呼吁取消 DATA 对所有从业者的要求。对 MOUD 的法规和监管历史的了解,可能对立法和政策行动继续重塑临床实践至关重要。将 MOUD 培训纳入本科医学教育的标准,代表着医学界为未来 MOUD 放宽监管做好准备培训生的独特机会。事实上,已经提供或要求 MOUD 培训的医学院校已经成功地提高了医学生和毕业生对 MOUD 的知识、技能和态度。现有的符合 DATA 标准的虚拟和混合培训工具代表了一种可行的手段,可以确保为未来几代医生提供关键的学习机会,他们独特地准备好并愿意为 OUD 患者提供优质、循证的护理。

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