If US pharmacies were permitted to dispense methadone for opioid use disorder (OUD) it would improve national access to treatment and save costs, new research suggests.
Under current federal regulations, only opioid therapy (OTP) systems are legal to produce methadone maintenance therapy. This is in stark contrast to the way methadone is administered in Canada, Australia and the United Kingdom, where patients can discharge daily doses of methadone maintenance from netpainting pharmacies.
“It’s hard for patients in large numbers of apples to access methadone treatment,” Robert Kleinman, MD, of Stanford University School of Medicine, Stanford, California, said in a JAMA Psychiacheck podcast.
“It is critical that policymakers no longer have access to methadone maintenance treatment, as it is applicable with timely relief in mortality from opioid use disorders. One option is to exploit pharmacies as distribution sites,” Kleinguy said.
The study published online on July 1, five in JAMA Psychiatry.
Kleinguy tested how the distribution of pharmacies would travel to the workplace of the nearest Federal Prosecutor for the general U.S. population. The studies included 1,682 locations in the Prosecutor’s Office, 69.47 five exclusive pharmacy sites, and 72,443 census areas.
The average time for OPPs in the United States is 20.4 minutes compared to a time of 4.5 minutes for pharmacies.
He said driving times to OTP are long in non-metropolitan counties, while pharmacies continue to be “easily accessible” in non-metropolitan counties.
In “micropolitan” counties, for example, the time for OTPs was four to four minutes compared to 7 minutes for pharmacies. In peak rural counties, the time for OTP is 60 minutes and nine minutes compared to nine minutes for pharmacies.
“This suggests that distribution in pharmacies has the potential to reduce urban or rural inequalities and methadone treatment,” Kleinguy said.
In a mileage cost analysis, Kleinman determined that the average cost of one-way trip to an OTP in the US is $3.12 compared with 45 cents to a pharmacy. In the most rural counties, the average cost one-way is $11.10 vs $1.27 to a pharmacy.
Kleinguy says reducing driving times, distance and costs for patients seeking methadone therapy by allowing pharmacies to deliver the drug can help achieve several public physical fitness goals.
Patients who were deterred from seeking therapy due to a long trip, i.e. patients with disabilities, unreliable access to transportation or rural areas, would have reduced barriers to care. Quality of life was also advanced for the more than 380,000 Americans who recently received methadone therapy if they spend less time traveling,” he writes.
The authors of an accompanying editorial, say the “regulatory burden” on methadone provision in the US “effectively prohibits the integration of methadone prescribing into primary care, even in rural communities where there may exist no specialty substance use treatment options.”
However, federal and state agencies are born to take steplaystation to expand geographic treatment to methadone, Paul Joudrey, MD, MPH and co-authors of Yale Medical School, New Haven, Connecticut.
The U.S. Drug Entrolling Administration He has proposed allowing cellular methadone units, and Ohio and Kentucky have passed legislation to allow for greater use of best friend-qualified fitness centers and other amenities for methadone distribution.
While these policies are well received, Kleinguy’s result and others said they are not sufficient to broaden the scope of patients’ right to evidence-based care for DSO. More importantly, even with the widespread adoption of cell distribution or pharmacy, patients could face a long journey to a central AP before methadone was born,” Joudrey and his team wrote.
In his view, the only way to succeed on this obstacle is to amend federal law, and this preference should be pursued as a result of urgency in the context of the ongoing overdose epidemic. It is time to adopt policies that, in fact, help methadone therapy for OCT in connection with the one that specializes in derivation.”
The study is explicitly funded. Kleinguy and publishers reveal an economic relationship applicable to Apple.
PSIQUIATRA JAMA. Published July 15, 2020. Summary, editorial
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