Increasing access to opioid use disorder treatment by opening pharmacy-based medication units of opioid treatment programs

通过开设阿片类药物治疗项目的药房用药单位，增加获得阿片类药物使用障碍治疗的机会

• 批准号: 10679104
• 负责人: Li-Tzy Wu
• 金额: $ 71.83万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-15 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10679104
• 关键词: Address; Admission activity; Agreement; American; Area; Buprenorphine; Burn injury; Canada; Caring; Certification; Communities; Community Pharmacy; Community Physician; Community Surveys; Country; Data; Electronics; Elements; Enrollment; Epidemic; Geography; Health Professional; Health Services Accessibility; Improve Access; Individual; Instruction; Interview; Licensing; Location; Methadone; Methods; Modeling; Morbidity - disease rate; Opioid; Parents; Participant; Patient Care; Patients; Peer Review; Perception; Persons; Pharmaceutical Preparations; Pharmacists; Pharmacy Administration; Pharmacy facility; Physicians; Primary Care Physician; Provider; Publications; Publishing; Regulation; Research; Research Design; Rural; Sampling; Site; Specific qualifier value; Surveys; Time; Travel; Trust; United States Substance Abuse and Mental Health Services Administration; buprenorphine treatment; collaborative care; community engagement; contextual factors; cost effective; design; drug testing; experience; follow-up; implementation barriers; implementation facilitators; medication for opioid use disorder; methadone treatment; nonmetropolitan area; opioid epidemic; opioid mortality; opioid treatment program; opioid use disorder; retention rate; rural area; suburb; willingness; young adult

The US opioid overdose death epidemic has continued for over 20 years. Nonmetropolitan or rural areas with low capabilities of opioid use disorder (OUD) treatment are associated with significantly elevated rates of opioid overdose deaths. Many countries have increased OUD treatment access to reduce opioid morbidity by allowing community pharmacy dispensing of methadone for methadone maintenance treatment (MMT). MMT has been the most studied and longest utilized OUD treatment for about 55+ years. Federal regulations require MMT to be provided through one of about 1,860 SAMHSA certified opioid treatment programs (OTPs). MMT is considered less expensive (more affordable) and has higher treatment retention rates than buprenorphine treatment for OUD. Thus, MMT is a preferred treatment option for many individuals with OUD. However, the limited number of OPTs, limited capabilities of existing OTPs, and a long travel distance to an OTP are major barriers to accessing MMT, especially for persons with OUD in rural and suburban areas. Pharmacists are among the most trusted healthcare professionals. About 90% of Americans live within 5 miles of a community pharmacy. Federal regulations allow OTPs to obtain approvals to establish methadone medication units (MUs) at pharmacies (pharmacy MUs) to allow pharmacy administration and dispensing of methadone for MMT to expand treatment. MUs are managed by OTP directors of the parent OTP who have oversight of patient care at both the main OTP and MU location. MUs have been infrequently utilized in the US. Given the serious shortage of OUD providers in the US to address the escalating opioid overdose death epidemic, there is an urgent need to identify useful strategies of establishing MUs and to disseminate useful strategies of establishing MUs nationally to OTP directors and community pharmacists in the US. Built on the successful experience of the PI’s (Dr. Wu) research on developing physician-community pharmacist collaborative care models to engage community pharmacists in providing buprenorphine treatment care to patients with OUD (Wu et al., 2021a) and administration and dispensing of methadone for MMT (Wu et al., 2021b), we will conduct a survey of OTP directors (n=586) and community pharmacists (n=586) to identify OTP and community pharmacy facility/practice, individual, and contextual factors that are related to intentions to establish a MU. Guided by a mixed methods explanatory sequential design, we will also conduct follow-up qualitative interviews of a subsample of participants from each survey to further obtain in-depth data on MU implementation barriers and facilitators in the US. Due to the serious shortage of OUD providers and escalating rates of opioid deaths, this study is time-sensitive. This study will be the first effort in the US to identify MU implementation barriers and facilitators from both OTP directors and pharmacists. We will produce multiple peer-reviewed publications and an electronic toolkit for establishing MUs to quickly disseminate the toolkit and publications to OTP directors and pharmacists nationally.

美国阿片类药物过量死亡流行已持续 20 多年，在非大都市或农村地区。 阿片类药物使用障碍 (OUD) 治疗能力低下与阿片类药物使用率显着升高相关 许多国家增加了 OUD 治疗的可及性，以减少阿片类药物的发病率。 社区药房配发美沙酮用于美沙酮维持治疗 (MMT)。 研究和使用 OUD 治疗时间最长的药物已超过 55 年，联邦法规要求 MMT 通过约 1,860 个 SAMHSA 认证的阿片类药物治疗计划 (OTP) 之一提供。 被认为比丁丙诺啡更便宜（更实惠）并且治疗保留率更高 因此，MMT 是许多 OUD 患者的首选治疗选择。 然而，OPT 数量有限、现有 OTP 的能力有限以及到达 OTP 的距离较长 是获得 MMT 的主要障碍，特别是对于农村和郊区的 OUD 患者。 是最值得信赖的医疗保健专业人员之一，大约 90% 的美国人居住在社区 5 英里范围内。 联邦法规允许 OTP 获得建立美沙酮药物单位 (MU) 的批准。 在药房（药房 MU）允许药房管理和配发 MMT 的美沙酮 MU 由母公司 OTP 的 OTP 主管管理，他们负责监督患者护理工作。 由于严重短缺，主要的 OTP 和 MU 位置都很少使用。 美国的 OUD 提供商需要解决不断升级的阿片类药物过量死亡流行问题，迫切需要 确定建立 MU 的有用策略并传播建立 MU 的有用策略 面向美国全国的 OTP 主管和社区药剂师。 借鉴PI（吴博士）研究培养医师社区药师的成功经验 协作护理模式让社区药剂师参与提供丁丙诺啡治疗护理 OUD 患者（Wu 等人，2021a）以及为 MMT 施用和分配美沙酮（Wu 等人，2021a） 2021b)，我们将对 OTP 主管 (n=586) 和社区药剂师 (n=586) 进行调查，以识别 OTP 和与意图相关的社区药房设施/实践、个人和背景因素 建立MU。以混合方法解释序贯设计为指导，我们还将进行后续工作。 对每项调查的参与者子样本进行定性访谈，以获得有关 MU 的进一步深入数据 美国的实施障碍和促进因素。 由于 OUD 提供者严重短缺以及阿片类药物死亡率不断上升，这项研究具有时间敏感性。 这项研究将是美国首次从 OTP 中确定 MU 实施障碍和促进因素 我们将为董事和药剂师制作多种经过同行评审的出版物和电子工具包。 建立 MU，以便向全国 OTP 主管和药剂师快速传播工具包和出版物。