A Systematic Review of State Office-Based Buprenorphine Treatment Laws Effective During 2022: Counseling, Dosage, and Visit Frequency Requirements.

Substance use & addiction journal Pub Date : 2024-04-01 Epub Date: 2024-01-30 DOI:10.1177/29767342231223721
Barbara Andraka-Christou, Olivia K Golan, Michelle Williams, Scott Buksbaum, Adam J Gordon, Bradley D Stein
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Abstract

Background: 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.

Methods: 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.

Results: 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.).

Conclusions: 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.

2022 年生效的州办公室丁丙诺啡治疗法系统回顾:咨询、剂量和就诊频率要求。
背景: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)的豁免要求和患者限制,但一些州可能仍有政策对 OBBT 提供者施加联邦法律未要求的要求:我们在 2022 年 8 月 11 日至 11 月 30 日期间,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,收集了美国 50 个州和哥伦比亚特区(即 51 个辖区)的法规和条例。然后,我们使用模板分析法(一种演绎-归纳混合定性方法)对法律内容进行了分析:2022 年有 10 个辖区(20%)规定了 OBBT 咨询、剂量和/或就诊频率。有四个辖区在所审查的每种 OBBT 政策类别中至少有一项法律。五分之一的辖区制定了联邦法律未要求的 OBBT 政策。根据 2021 年的公开数据,其中五个辖区属于人均用药过量死亡率最高的辖区。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,但我们的研究结果表明,至少一些司法管辖区还有其他 OBBT 要求,如咨询、剂量和/或频率要求。鉴于目前阿片类药物过量危机的严重性,政策制定者应仔细考虑 OBBT 要求的循证程度。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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