Joudrey Paul J, Halpern Dylan, Lin Qinyun, Paykin Susan, Mair Christina, Kolak Marynia
Center for Research on Health Care, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA 15213, United States.
Data Science Institute, University of Chicago, Chicago, IL 60637, United States.
Health Aff Sch. 2023 Nov;1(5). doi: 10.1093/haschl/qxad061. Epub 2023 Oct 7.
Methadone treatment for opioid use disorder is not available in most suburban and rural US communities. We examined 2 options to expand methadone availability: (1) addiction specialty physician or (2) all clinician prescribing. Using 2022 Health Resources and Services Administration data, we used mental health professional shortage areas to indicate the potential of addiction specialty physician prescribing and the location of federally qualified health centers (ie, federally certified primary care clinics) to indicate the potential of all clinician prescribing. We examined how many census tracts without an available opioid treatment program (ie, methadone clinic) are (1) located within a mental health professional shortage area and (2) are also without an available federally qualified health center. Methadone was available in 49% of tracts under current regulations, 63% of tracts in the case of specialist physician prescribing, and 86% of tracts in the case of all clinician prescribing. Specialist physician prescribing would expand availability to an additional 12% of urban, 18% of suburban, and 16% of rural tracts, while clinician prescribing would expand to an additional 30% of urban, 53% of suburban, and 58% of rural tracts relative to current availability. Results support enabling broader methadone prescribing privileges to ensure equitable treatment access, particularly for rural communities.
在美国大多数郊区和农村社区，没有用于治疗阿片类药物使用障碍的美沙酮治疗服务。我们研究了两种扩大美沙酮可及性的方案：（1）成瘾专科医生处方或（2）所有临床医生处方。利用2022年卫生资源与服务管理局的数据，我们用心理健康专业人员短缺地区来表明成瘾专科医生处方的潜力，并用联邦合格健康中心（即获得联邦认证的初级保健诊所）的位置来表明所有临床医生处方的潜力。我们研究了有多少没有可用阿片类药物治疗项目（即美沙酮诊所）的人口普查区（1）位于心理健康专业人员短缺地区内，以及（2）也没有可用的联邦合格健康中心。根据现行规定，49%的人口普查区有美沙酮可用；在专科医生处方的情况下，63%的人口普查区有美沙酮可用；在所有临床医生处方的情况下，86%的人口普查区有美沙酮可用。相对于目前的可及性，专科医生处方将使城市地区额外12%、郊区地区额外18%和农村地区额外16%的人口普查区有美沙酮可用，而临床医生处方将使城市地区额外30%、郊区地区额外53%和农村地区额外58%的人口普查区有美沙酮可用。研究结果支持赋予更广泛的美沙酮处方特权，以确保公平的治疗可及性，特别是对农村社区而言。
