From the Massachusetts General Hospital, Harvard Medical School, Boston, MA (EJS, ZZ, PP, MSJ); Sloan School of Management, Massachusetts Institute of Technology, Cambridge, MA (TYL, CD, MSJ); Harvard T.H. Chan School of Public Health, Boston, MA (TYL); Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA (BB); and Veterans Affairs and Stanford University Medical Centers, Palo Alto, CA (KH).
J Addict Med. 2023;17(4):439-446. doi: 10.1097/ADM.0000000000001153. Epub 2023 Feb 28.
Because buprenorphine treatment of opioid use disorder reduces opioid overdose deaths (OODs), expanding access to care is an important policy and clinical care goal. Policymakers must choose within capacity limitations whether to expand the number of people with opioid use disorder who are treated or extend duration for existing patients. This inherent tradeoff could be made less acute with expanded buprenorphine treatment capacity.
To inform such decisions, we used a validated simulation model to project the effects of increasing buprenorphine treatment-seeking, average episode duration, and capacity (patients per provider) on OODs in the United States from 2023 to 2033, varying the start time to assess the effects of implementation delays.
Results show that increasing treatment duration alone could cost lives in the short term by reducing capacity for new admissions yet save more lives in the long term than accomplished by only increasing treatment seeking. Increasing provider capacity had negligible effects. The most effective 2-policy combination was increasing capacity and duration simultaneously, which would reduce OODs up to 18.6% over a decade. By 2033, the greatest reduction in OODs (≥20%) was achieved when capacity was doubled and average duration reached 2 years, but only if the policy changes started in 2023. Delaying even a year diminishes the benefits. Treatment-seeking increases were equally beneficial whether they began in 2023 or 2025 but of only marginal benefit beyond what capacity and duration achieved.
If policymakers only target 2 policies to reduce OODs, they should be to increase capacity and duration, enacted quickly and aggressively.
由于丁丙诺啡治疗阿片类药物使用障碍可降低阿片类药物过量死亡（OOD），因此扩大治疗范围是一项重要的政策和临床护理目标。决策者必须在能力限制范围内做出选择，是扩大接受阿片类药物使用障碍治疗的人数，还是延长现有患者的治疗时间。通过扩大丁丙诺啡治疗能力，可以减少这种固有的权衡取舍。
为了为这些决策提供信息，我们使用经过验证的模拟模型来预测从 2023 年到 2033 年，增加丁丙诺啡治疗寻求、平均发作持续时间和能力（每位提供者的患者）对美国 OOD 的影响，变化开始时间以评估实施延迟的影响。
结果表明，仅增加治疗持续时间短期内可能会因减少新入院的能力而导致死亡，但从长期来看，其效果要好于仅增加治疗寻求。增加提供者能力的效果可以忽略不计。最有效的 2 项政策组合是同时增加能力和持续时间，这将在十年内减少多达 18.6%的 OOD。到 2033 年，如果政策变化从 2023 年开始，最大程度减少 OOD（≥20%）的效果是将能力提高一倍，平均持续时间达到 2 年，但即使延迟一年也会降低收益。治疗寻求的增加无论是在 2023 年还是 2025 年开始，都同样有益，但在能力和持续时间所取得的效果之外，只有边际收益。
如果决策者仅针对减少 OOD 的 2 项政策，那么他们应该迅速积极地增加能力和持续时间。
