■需要当地水平的数据来了解2021年4月对开药丁丙诺啡的X豁免培训要求的放松是否转化为丁丙诺啡治疗的增加。
■评估X豁免培训要求的放宽是否与因阿片类药物使用障碍而放弃和开出丁丙诺啡的临床医生人数以及接受治疗的患者人数的变化有关。
■这项连续横断面研究使用了对健康社区研究(HCS)的2020-2022年数据的中断时间序列分析,集群随机化,等待名单控制试验。4个州的城市和农村社区(肯塔基州,马萨诸塞州,纽约,和俄亥俄州)的阿片类药物过量负担很高,但尚未接受HCS干预。
■放宽X豁免培训要求(即,允许培训豁免X豁免)于2021年4月28日生效。
■每月免除X名临床医生的人数,X豁免的丁丙诺啡处方者,接受丁丙诺啡的患者分别在一个州内的社区中进行汇总。使用分段线性回归模型按状态估计政策前后的变化。
■33个参与的HCS社区的人数包括马萨诸塞州的347863人,815794在肯塔基州,971490在纽约,和1623958在俄亥俄州。年龄分布(18-35岁:范围,29.4%-32.4%;35-54年:范围,29.9%-32.5%;≥55年:范围,35.7%-39.3%)和性别(女性:范围,51.1%-52.6%)在社区之间相似。在所有州的政策变更前,X豁免临床医生的数量都有暂时的增加,在除俄亥俄州外的每个州的政策变更后时期,从马萨诸塞州社区的5.2%(95%CI,3.1%-7.3%)到肯塔基州社区的8.4%(95%CI,6.5%-10.3%)不等。只有肯塔基州的社区显示与政策变化相关的处方丁丙诺啡的X豁免临床医生数量增加(相对增加,3.2%;95%CI,1.5%-4.9%),而其他州的社区没有变化或减少。同样,只有马萨诸塞州的社区经历了与政策变化相关的丁丙诺啡患者的增加(相对增加,1.7%;95%CI,0.8%-2.6%),而其他州的社区没有变化。
■在这项连续的横断面研究中,放宽X豁免培训要求与X豁免临床医师人数增加相关,但与丁丙诺啡处方者或接受丁丙诺啡的患者人数增加并不一致.这些发现表明,训练要求可能不是扩大丁丙诺啡治疗的主要障碍。
UNASSIGNED: Local-level data are needed to understand whether the relaxation of X-waiver training requirements for prescribing buprenorphine in April 2021 translated to increased buprenorphine treatment.
UNASSIGNED: To assess whether relaxation of X-waiver training requirements was associated with changes in the number of clinicians waivered to and who prescribe buprenorphine for opioid use disorder and the number of patients receiving treatment.
UNASSIGNED: This serial cross-sectional study uses an interrupted time series analysis of 2020-2022 data from the HEALing Communities Study (HCS), a cluster-randomized, wait-list-controlled trial. Urban and rural communities in 4 states (Kentucky, Massachusetts, New York, and Ohio) with a high burden of opioid overdoses that had not yet received the HCS intervention were included.
UNASSIGNED: Relaxation of X-waiver training requirements (ie, allowing training-exempt X-waivers) on April 28, 2021.
UNASSIGNED: The monthly number of X-waivered clinicians, X-waivered buprenorphine prescribers, and patients receiving buprenorphine were each summed across communities within a state. Segmented linear regression models to estimate pre- and post-policy change by state were used.
UNASSIGNED: The number of individuals in 33 participating HCS communities included 347 863 in Massachusetts, 815 794 in Kentucky, 971 490 in New York, and 1 623 958 in Ohio. The distribution of age (18-35 years: range, 29.4%-32.4%; 35-54 years: range, 29.9%-32.5%; ≥55 years: range, 35.7%-39.3%) and sex (female: range, 51.1%-52.6%) was similar across communities. There was a temporal increase in the number of X-waivered clinicians in the pre-policy change period in all states, which further increased in the post-policy change period in each state except Ohio, ranging from 5.2% (95% CI, 3.1%-7.3%) in Massachusetts communities to 8.4% (95% CI, 6.5%-10.3%) in Kentucky communities. Only communities in Kentucky showed an increase in the number of X-waivered clinicians prescribing buprenorphine associated with the policy change (relative increase, 3.2%; 95% CI, 1.5%-4.9%), while communities in other states showed no change or a decrease. Similarly, only communities in Massachusetts experienced an increase in patients receiving buprenorphine associated with the policy change (relative increase, 1.7%; 95% CI, 0.8%-2.6%), while communities in other states showed no change.
UNASSIGNED: In this serial cross-sectional study, relaxation of X-waiver training requirements was associated with an increase in the number of X-waivered clinicians but was not consistently associated with an increase in the number of buprenorphine prescribers or patients receiving buprenorphine. These findings suggest that training requirements may not be the primary barrier to expanding buprenorphine treatment.