Article de Périodique
Buprenorphine deregulation as an opioid crisis policy response - A comparative analysis between France and the United States (2023)
Auteur(s) :
SUD, A. ;
CHIU, K. ;
FRIEDMAN, J. ;
DUPOUY, J.
Année :
2023
Page(s) :
art. 104161
Langue(s) :
Anglais
Domaine :
Autres substances / Other substances ; Drogues illicites / Illicit drugs
Thésaurus géographique
ETATS-UNIS
;
FRANCE
Thésaurus mots-clés
BUPRENORPHINE
;
OPIOIDES
;
COMPARAISON
;
POLITIQUE
;
SANTE PUBLIQUE
;
TRAITEMENT DE MAINTENANCE
;
EPIDEMIOLOGIE
;
MORTALITE
;
SURDOSE
;
DISPOSITIF DE SOIN
;
SOINS DE PREMIER RECOURS
Résumé :
Background: In passing the Maintstreaming Addiction Treatment Act, the United States has abolished its federal X waiver, considered a major barrier to the wider buprenorphine prescribing needed to respond to opioid-related harms. Advocates for this policy have drawn on the French response of deregulating buprenorphine prescribing to address increasing overdose mortality around the turn of the millennium. So far, such policy advocacy has incompletely accounted for contextual and health system differences between the two countries.
Methods: Using the health system dynamics framework, this analysis compares France from 1995 to 2003 (the relevant period of buprenorphine reform) to the US from 2018 until today (the comparison period to explore potential impacts of reform). We used it to guide examination of a) contextual issues relating to opioid use epidemiology and b) health system factors including prescriber supply, sector organization, and insurance coverage for primary care to draw relevant policy learning for the contemporary US.
Results: We identified that the US had a 22.5-fold higher mortality rate and a 2.3-fold higher opioid use disorder (OUD) rate compared to France, despite having rates of prescribed buprenorphine per-capita higher than, and per-person with OUD comparable to, than that of France. These wide gulfs between the scales and nature of the problems between France and the US suggest that relaxing restrictions on buprenorphine prescribing through abolishing the X waiver will be insufficient for achieving hoped-for reductions in overdose mortality.
Conclusion: Health system strengthening with a focus on improvements in primary care prescriber supply, coverage, and coordination are likely higher yield policy complements to relaxing buprenorphine regulation. Such an approach would better prepare the US to adapt to ongoing dynamics and uncertainties in the opioid crisis and to optimize the already relatively high levels of buprenorphine prescribing.
Methods: Using the health system dynamics framework, this analysis compares France from 1995 to 2003 (the relevant period of buprenorphine reform) to the US from 2018 until today (the comparison period to explore potential impacts of reform). We used it to guide examination of a) contextual issues relating to opioid use epidemiology and b) health system factors including prescriber supply, sector organization, and insurance coverage for primary care to draw relevant policy learning for the contemporary US.
Results: We identified that the US had a 22.5-fold higher mortality rate and a 2.3-fold higher opioid use disorder (OUD) rate compared to France, despite having rates of prescribed buprenorphine per-capita higher than, and per-person with OUD comparable to, than that of France. These wide gulfs between the scales and nature of the problems between France and the US suggest that relaxing restrictions on buprenorphine prescribing through abolishing the X waiver will be insufficient for achieving hoped-for reductions in overdose mortality.
Conclusion: Health system strengthening with a focus on improvements in primary care prescriber supply, coverage, and coordination are likely higher yield policy complements to relaxing buprenorphine regulation. Such an approach would better prepare the US to adapt to ongoing dynamics and uncertainties in the opioid crisis and to optimize the already relatively high levels of buprenorphine prescribing.
Affiliation :
Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
Humber River Hospital, Toronto, Canada
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
Center for Social Medicine and Humanities, University of California, Los Angeles, CA, USA
University Department of General Medicine, University of Toulouse, Faculty of Medicine, Toulouse, France
Inserm UMR1295, University of Toulouse III, Faculty of Medicine, Toulouse, France
Humber River Hospital, Toronto, Canada
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
Center for Social Medicine and Humanities, University of California, Los Angeles, CA, USA
University Department of General Medicine, University of Toulouse, Faculty of Medicine, Toulouse, France
Inserm UMR1295, University of Toulouse III, Faculty of Medicine, Toulouse, France
Cote :
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