Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Addiction. 2023 Nov;118(11):2215-2219. doi: 10.1111/add.16291. Epub 2023 Jul 11.
AIMS, DESIGN AND SETTING: We sought to describe longitudinal trends in buprenorphine receipt and buprenorphine-waivered providers in the United States from 2003 to 2021 and measure whether the relationship between the two differed after capacity-building strategies were enacted nationally in 2017. This was a retrospective study of two separate cohorts covering the years 2003-21, testing whether the association between two trends in these cohorts changed comparing 2003 to 2016 and from 2017 to 2021, among buprenorphine providers in the United States, regardless of treatment setting. Patients receiving dispensed buprenorphine at retail pharmacies.
All providers who have obtained a waiver to prescribe buprenorphine in the United States, and an estimate of the annual number of patients who had buprenorphine for opioid use disorder (OUD) dispensed to them at a retail pharmacy.
We synthesized and summarized data from multiple sources to assess the cumulative number of buprenorphine-waivered providers over time. We used national-level prescription data from IQVIA to estimate annual buprenorphine receipt for OUD.
From 2003 to 2021, the number of buprenorphine-waivered providers in the United States increased from fewer than 5000 in the first 2 years of Food and Drug Administration (FDA) approval to more than 114 000 in 2021, while patients receiving buprenorphine products for OUD increased from approximately 19 000 to more than 1.4 million. The strength of association between waivered providers and patients is significantly different before and after 2017 (P < 0.001). From 2003 to 2016, for each additional provider, there was an average increase of 32.1 [95% confidence interval (CI) = 28.7-35.6] patients, but an increase of only 4.6 (95% CI= 3.5-5.7) patients for each additional provider, beginning in 2017.
In the United States, the relationship between the rates of growth in buprenorphine providers and patients became weaker after 2017. While efforts to increase buprenorphine-waivered providers were successful, there was less success in translating that into significant increases in buprenorphine receipt.
目的、设计和设置：我们旨在描述 2003 年至 2021 年美国丁丙诺啡接受者和丁丙诺啡豁免提供者的纵向趋势，并衡量在 2017 年全国实施能力建设战略后，这两者之间的关系是否有所不同。这是一项回顾性研究，涉及两个独立的队列，涵盖了 2003 年至 21 年，检验了这两个队列中的两个趋势之间的关联是否在 2003 年至 2016 年以及 2017 年至 2021 年期间发生了变化，研究对象为美国的丁丙诺啡提供者，无论治疗环境如何。在零售药店接受丁丙诺啡配药的患者。
所有在美国获得丁丙诺啡处方豁免的提供者，以及在美国零售药店接受丁丙诺啡治疗阿片类药物使用障碍（OUD）的患者的年度估计人数。
我们综合并总结了来自多个来源的数据，以评估随时间推移丁丙诺啡豁免提供者的累计数量。我们使用 IQVIA 的国家处方数据来估计 OUD 的年度丁丙诺啡接受情况。
从 2003 年到 2021 年，美国的丁丙诺啡豁免提供者数量从 FDA 批准后的头两年的不到 5000 人增加到 2021 年的超过 114000 人，而接受丁丙诺啡治疗 OUD 的患者人数从大约 19000 人增加到超过 140 万人。豁免提供者和患者之间的关联强度在 2017 年前后有显著差异（P<0.001）。从 2003 年到 2016 年，每增加一名提供者，平均增加 32.1 名（95%置信区间 [CI] = 28.7-35.6）患者，但从 2017 年开始，每增加一名提供者，仅增加 4.6 名（95% CI = 3.5-5.7）患者。
在美国，丁丙诺啡提供者和患者增长率之间的关系在 2017 年后变得较弱。尽管增加丁丙诺啡豁免提供者的努力取得了成功，但在将其转化为丁丙诺啡接受率的显著增加方面却不太成功。
