Guido Madison R, Hauschild Maia H, Tookes Hansel E, Bartholomew Tyler S, Suarez Edward
University of Miami Miller School of Medicine, Miami, FL 33136, USA.
University of Miami Miller School of Medicine, Miami, FL 33136, USA.
J Subst Use Addict Treat. 2025 Jan;168:209535. doi: 10.1016/j.josat.2024.209535. Epub 2024 Oct 5.
Buprenorphine is a first-line treatment for opioid use disorder (OUD), essential for reducing opioid overdose mortality and improving treatment retention. Despite federal policies that mandate the acceptance of buprenorphine in recovery residences, individuals in South Florida taking this medication often face significant barriers to admission. This study uses a secret shopper survey to examine whether federal policies regarding prescribed buprenorphine use are being violated in South Florida recovery residences.
We selected recovery residences in South Florida due to the region's high opioid overdose death rate and its prominence as a recovery hub. From a list of 141 Florida Association of Recovery Residences (FARR)-certified residences in Palm Beach, Broward, and Miami-Dade, we randomly surveyed 100 programs across all treatment levels (I-IV) using a standardized script. The primary outcome was whether residences accepted individuals taking buprenorphine, classified into three categories: (1) unconditional acceptance, where any person taking buprenorphine was accepted; (2) denial, where admission was refused for all individuals taking buprenorphine; and (3) conditional acceptance, where admission was granted under specific conditions. Secondary outcomes included requirements for conditional acceptance, such as dose limits or tapering policies.
The distribution of the 100 surveyed recovery residences was comparable to the 141 FARR-certified facilities: 67 % were in Palm Beach, 31 % in Broward, and 2 % in Miami-Dade. Most residences (55 %) were level II certified, followed by 26 % level IV, 14 % level I, and 5 % level III. Sixteen percent of residences permitted admission of individuals taking any buprenorphine dose, 31 % had conditional policies, and 53 % prohibited buprenorphine. The maximum acceptance across all counties and levels was 20 %. No significant differences were observed by county (p = 0.61) or facility level (p = 0.29). Of 31 residences with conditional policies, 25.8 % (n = 8) required a mandatory taper, 38.7 % (n = 12) allowed a maximum 8 mg daily dosage, 12.9 % (n = 4) had a maximum 12 mg daily dosage, 6.5 % (n = 2) had a maximum 16 mg daily dosage, 6.5 % (n = 2) required a provider letter, and 9.7 % (n = 3) did not provide further information.
Access to FARR-certified recovery residences is severely limited for individuals in South Florida taking buprenorphine. Urgent action is needed to improve access to evidence-based OUD treatments, address complexities influencing recovery residence policy and practice, and ensure appropriate allocation of public funds like State Opioid Response dollars.
丁丙诺啡是阿片类物质使用障碍（OUD）的一线治疗药物，对降低阿片类药物过量致死率及提高治疗依从性至关重要。尽管有联邦政策要求康复住所接受使用丁丙诺啡的患者，但南佛罗里达州服用此药的个体在入住时往往面临重大障碍。本研究采用暗访调查，以检验南佛罗里达州康复住所是否违反了关于使用处方丁丙诺啡的联邦政策。
由于该地区阿片类药物过量死亡率高且是重要的康复中心，我们选择了南佛罗里达州的康复住所。从棕榈滩、布劳沃德和迈阿密 - 戴德县141家经佛罗里达州康复住所协会（FARR）认证的住所名单中，我们使用标准化脚本对所有治疗级别（I - IV）的100个项目进行了随机调查。主要结果是住所是否接受服用丁丙诺啡的个体，分为三类：（1）无条件接受，即接受任何服用丁丙诺啡的人；（2）拒绝，即拒绝所有服用丁丙诺啡的个体入住；（3）有条件接受，即在特定条件下准予入住。次要结果包括有条件接受的要求，如剂量限制或递减政策。
100个被调查的康复住所的分布与141家经FARR认证的机构相似：67%位于棕榈滩，31%位于布劳沃德，2%位于迈阿密 - 戴德。大多数住所（55%）为二级认证，其次是26%为四级认证，14%为一级认证，5%为三级认证。16%的住所允许任何剂量丁丙诺啡使用者入住，31%有条件政策，53%禁止使用丁丙诺啡。所有县和级别中的最大接受率为20%。未观察到县（p = 0.61）或机构级别（p = 0.29）之间的显著差异。在31个有条件政策的住所中，25.8%（n = 8）要求强制递减，38.7%（n = 12）允许每日最大剂量8毫克，12.9%（n = 4）允许每日最大剂量12毫克，6.5%（n = 2）允许每日最大剂量16毫克，6.5%（n = 2）要求提供医生信函，9.7%（n = 3）未提供更多信息。
对于南佛罗里达州服用丁丙诺啡的个体而言，获得FARR认证的康复住所的机会极为有限。需要立即采取行动，以改善获得循证OUD治疗的机会，解决影响康复住所政策和实践的复杂性问题，并确保像国家阿片类药物应对资金这样的公共资金得到合理分配。
