Expanding Access to Medications for Opioid Use Disorder: Federal Policy Is Only a Part of the Solution

• Published in: American journal of public health (1971) 2024-07, Vol.114 (7), p.693-695
• Main Authors: Heidari, Omeid, Banta-Green, Caleb J
• Format: Article
• Language: English
• Subjects: Access; Analgesics, Opioid - therapeutic use; Buprenorphine; Buprenorphine - therapeutic use; COVID-19; Data; Data systems; Drug abuse; Drug addiction; Drug use; Drugs; Emergency response; Fatalities; Federal policy; Harm reduction; Health care; Health care industry; Health Policy; Health services; Health Services Accessibility; Health services utilization; Heroin; Humans; Mental health care; Mental health services; Methadone; Mortality; Narcotic Antagonists - therapeutic use; Narcotics; Nurse practitioners; Opiate Substitution Treatment; Opioid-Related Disorders - drug therapy; Opioids; Physician assistants; Poisoning; Primary care; Public finance; Public health; Substance abuse; Substance abuse treatment; Substance use disorder; Treatment programs; United States
• ISSN: 0090-0036; 1541-0048; 1541-0048
• DOI: 10.2105/AJPH.2024.307715

[...]NP and PA prescribers are willing to prescribe buprenorphine for opioid use disorder; given the potentially greater accessibility of these prescribers, this is most welcome. NPF arrived in the western United States several years after it hit the East Coast, with substantial increases in mortality roughly coinciding with the onset of COVID-19.7 This perfect storm had devastating impacts on public health, in part because of the physical, emotional, and financial turmoil resulting from COVID-19 intersecting with the increased challenges of starting on buprenorphine, related to NPF replacing heroin as the primary illicit opioid.8 Opioid-involved poisoning deaths in Washington State increased from 11.3 per 100 000 in 2019 to 26.3 per 100 000 in 2022; 90% of the deaths in 2022 involved an NPF.9 Recent survey and interview data from Washington State indicate that most people who use opioids want to stop or reduce their opioid use, want to utilize buprenorphine or methadone, and often are unable or unwilling to access health care in traditional settings.10 A new care model provides access to medications at communitybased programs, including harm reduction programs providing safer use supplies, and has demonstrated substantial demand, strong engagement, and positive outcomes.11 This third model, outside of primary care and opioid treatment programs, is needed to help address this massive MOUD treatment and harm reduction gap. Data systems that integrate health care, first responder, MOUD utilization, and other services data should be strengthened and regularly analyzed, with results widely disseminated.12 In summary, federal policy can open doors to broader access to buprenorphine, but specific system and prescriber actions need to happen to take advantage of these new possibilities. Substance Abuse and Mental Health Services Administration.