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首页> 外文期刊>Journal of substance abuse treatment >Medication treatment for opioid use disorder in the age of COVID-19: Can new regulations modify the opioid cascade?
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Medication treatment for opioid use disorder in the age of COVID-19: Can new regulations modify the opioid cascade?

机译：适用于Covid-19时代阿片类药物使用障碍的药物治疗：可以新规定修饰阿片类药物级联吗？

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The temporary loosening of regulations governing methadone and buprenorphine treatment for opioid use disorder (OUD) in the U.S., instituted to prevent the spread of COVID-19, has created an opportunity to explore the effectiveness of new models of care for people with OUD. The opioid cascade describes the current status of the treatment system, where only a fraction of people with OUD initiate effective medication treatment for OUD (MOUD), and of those only a fraction is retained in treatment. Regulatory changes-such as availability of larger take-home supplies of methadone and buprenorphine initiated via telemedicine (e.g., no initial in person visit; telemedicine buprenorphine permitted across state lines)-could modify the cascade, by reducing the burden and increasing the attractiveness, availability, and feasibility of MOUD both for people with OUD and for providers. We review examples of more liberal MOUD regimens, including the implementation of buprenorphine in France in the 1990s, primary care-based methadone in Canada, and low-threshold buprenorphine models. Research is needed to document whether new models implemented in the U.S. in the wake of COVID-19 are successful, and whether safety concerns, such as diversion and misuse, emerge. We discuss barriers to implementation, including racial and ethnic health disparities, and lack of knowledge and reluctance among potential providers of MOUD. We suggest that the urgency and public spiritedness of the response to COVID-19 be harnessed to make gains on the opioid cascade, inspiring prescribers, health systems, and communities to embrace the delivery of MOUD to meet the needs of an increasingly vulnerable population.
机译：在美国，为了2019冠状病毒疾病的传播，暂时停止了美沙酮和丁丙诺啡治疗的法规，这为探索新的护理模式对ODE患者的有效性创造了机会。阿片类药物级联反应描述了治疗系统的现状，其中只有一小部分患有OUD的人开始对OUD（MOUD）进行有效的药物治疗，而这些人中只有一小部分被保留在治疗中。监管变化，如通过远程医疗（例如，无首次亲自就诊；跨州线允许远程医疗丁丙诺啡）启动的更多美沙酮和丁丙诺啡带回家供应的可用性，可以通过减轻负担，增加MOUD对OUD患者和提供者的吸引力、可用性和可行性，来改变级联效应。我们回顾了更自由的MOUD方案的例子，包括20世纪90年代在法国实施丁丙诺啡、加拿大基于初级保健的美沙酮以及低阈值丁丙诺啡模型。2019冠状病毒疾病的成功实施，以及是否存在安全问题，如转移和滥用，需要研究，以证明美国是否实施了新的模型。我们讨论了实施的障碍，包括种族和民族健康差异，以及潜在的MOUD提供者缺乏知识和不情愿。我们建议，应对2019冠状病毒疾病的紧迫性和公众精神，在阿片类药物级联反应中获益，鼓励处方药、卫生系统和社区接受MOPD的输送以满足日益脆弱人群的需要。

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