School of Global Health Management and Informatics, University of Central Florida, Orlando, FL, USA.
Department of Internal Medicine, University of Central Florida, Orlando, FL, USA.
Subst Use Addctn J. 2024 Apr;45(2):278-291. doi: 10.1177/29767342231223721. Epub 2024 Jan 30.
Buprenorphine is among the most effective treatments for opioid use disorder. Even though the federal government recently eliminated the waiver requirement and patient limits applicable to office-based buprenorphine treatment (OBBT), among other settings, some states may still have policies imposing requirements on OBBT providers not required by federal law.
We collected statutes and regulations from 50 US states and the District of Columbia (ie, 51 jurisdictions) between August 11 and November 30, 2022 using the Nexis Uni legal database and search terms related to OBBT counseling, dosage, and/or frequency of visits. We then used template analysis, a mixed deductive-inductive qualitative method, to analyze legal content.
Ten jurisdictions (20%) in 2022 had an OBBT counseling, dosage, and/or visit frequency requirement. Four jurisdictions had at least one law in each OBBT policy category examined. One-fifth of jurisdictions have OBBT policies not required under federal law. Five of these jurisdictions are among those with the highest overdose death rates per capita, according to publicly available data from 2021. Some OBBT requirements could potentially limit clinician interest in offering buprenorphine treatment or result in inadequate care (eg, if dosage limitations are too low.).
Even though a federal waiver is no longer required for OBBT, our results suggests that at least some jurisdictions have other OBBT requirements, such as counseling, dosage, and/or frequency requirements. Given the severity of the ongoing opioid overdose crisis, policymakers should carefully consider the extent to which OBBT requirements are evidence based.
丁丙诺啡是治疗阿片类药物使用障碍最有效的方法之一。尽管联邦政府最近取消了适用于基于办公室的丁丙诺啡治疗（OBBT）等环境的豁免要求和患者限制，但一些州可能仍然有政策对 OBBT 提供者施加联邦法律未要求的要求。
我们使用 Nexis Uni 法律数据库和与 OBBT 咨询、剂量和/或就诊频率相关的搜索词，于 2022 年 8 月 11 日至 11 月 30 日从美国 50 个州和哥伦比亚特区（即 51 个司法管辖区）收集法规和条例。然后，我们使用模板分析，一种混合演绎-归纳的定性方法，对法律内容进行分析。
2022 年，有 10 个司法管辖区（20%）有 OBBT 咨询、剂量和/或就诊频率要求。四个司法管辖区在审查的每个 OBBT 政策类别中都至少有一项法律。五分之一的司法管辖区有联邦法律未要求的 OBBT 政策。根据 2021 年公开提供的数据，其中五个司法管辖区的人均过量死亡率最高。一些 OBBT 要求可能会限制临床医生提供丁丙诺啡治疗的兴趣或导致护理不足（例如，如果剂量限制过低）。
尽管 OBBT 不再需要联邦豁免，但我们的结果表明，至少有一些司法管辖区有其他 OBBT 要求，例如咨询、剂量和/或频率要求。考虑到阿片类药物过量危机的严重性，政策制定者应仔细考虑 OBBT 要求在多大程度上基于证据。
