Impact of the Communities That HEAL Intervention on Buprenorphine-Waivered Practitioners and Buprenorphine Prescribing

Author:

Stopka Thomas J.1,Babineau Denise C.2,Gibson Erin B.3,Knott Charles E.2,Cheng Debbie M.4,Villani Jennifer5,Wai Jonathan M.6,Blevins Derek6,David James L.6,Goddard-Eckrich Dawn A.6,Lofwall Michelle R.7,Massatti Richard8,DeFiore-Hyrmer Jolene9,Lyons Michael S.10,Fanucchi Laura C.7,Harris Daniel R.11,Talbert Jeffery11,Hammerslag Lindsey7,Oller Devin7,Balise Raymond R.12,Feaster Daniel J.12,Soares William13,Zarkin Gary A.2,Glasgow LaShawn2,Oga Emmanuel2,McCarthy John2,D’Costa Lauren2,Chahine Rouba2,Gomori Steve2,Dalvi Netrali14,Shrestha Shikhar1,Garner Chad9,Shadwick Aimee15,Salsberry Pamela16,Konstan Michael W.17,Freisthler Bridget10,Winhusen John18,El-Bassel Nabila6,Samet Jeffrey H.319,Walsh Sharon L.7

Affiliation:

1. Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts

2. Research Triangle Institute, Research Triangle Park, North Carolina

3. Department of Medicine, Boston Medical Center, Boston, Massachusetts

4. Boston University School of Public Health, Boston, Massachusetts

5. National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland

6. Department of Psychiatry, Columbia University; Division on Substance Use Disorders, New York State Psychiatric Institute, New York

7. College of Medicine, University of Kentucky Center on Drug and Alcohol Research, Lexington

8. Ohio Department of Mental Health and Addiction Services, Columbus

9. State of Ohio Board of Pharmacy, Columbus

10. College of Medicine, Ohio State University, Columbus

11. College of Pharmacy, University of Kentucky, Lexington

12. Department of Public Health Sciences, University of Miami, Miami, Florida

13. UMass Chan Medical School–Baystate, Springfield, Massachusetts

14. Office of Prescription Monitoring and Drug Control, Massachusetts Department of Public Health, Boston

15. RecoveryOhio, Office of Ohio Governor Mike DeWine, Columbus

16. Health Behavior and Health Promotion, Ohio State University, Columbus

17. Case Western Reserve University School of Medicine, Cleveland, Ohio

18. University of Cincinnati College of Medicine, Cincinnati, Ohio

19. Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, Massachusetts

Abstract

ImportanceBuprenorphine significantly reduces opioid-related overdose mortality. From 2002 to 2022, the Drug Addiction Treatment Act of 2000 (DATA 2000) required qualified practitioners to receive a waiver from the Drug Enforcement Agency to prescribe buprenorphine for treatment of opioid use disorder. During this period, waiver uptake among practitioners was modest; subsequent changes need to be examined.ObjectiveTo determine whether the Communities That HEAL (CTH) intervention increased the rate of practitioners with DATA 2000 waivers and buprenorphine prescribing.Design, Setting, and ParticipantsThis prespecified secondary analysis of the HEALing Communities Study, a multisite, 2-arm, parallel, community-level, cluster randomized, open, wait-list–controlled comparison clinical trial was designed to assess the effectiveness of the CTH intervention and was conducted between January 1, 2020, to December 31, 2023, in 67 communities in Kentucky, Massachusetts, New York, and Ohio, accounting for approximately 8.2 million adults. The participants in this trial were communities consisting of counties (n = 48) and municipalities (n = 19). Trial arm randomization was conducted using a covariate constrained randomization procedure stratified by state. Each state was balanced by community characteristics including urban/rural classification, fatal opioid overdose rate, and community population. Thirty-four communities were randomized to the intervention and 33 to wait-list control arms. Data analysis was conducted between March 20 and September 29, 2023, with a focus on the comparison period from July 1, 2021, to June 30, 2022. Data analysis was re-run on June 6, 2024, using a revised set of data that was locked on May 31, 2024.InterventionWaiver trainings and other educational trainings were offered or supported by the HEALing Communities Study research sites in each state to help build practitioner capacity.Main Outcomes and MeasuresThe rate of practitioners with a DATA 2000 waiver (overall, and stratified by 30-, 100-, and 275-patient limits) per 100 000 adult residents aged 18 years or older during July 1, 2021, to June 30, 2022, were compared between the intervention and wait-list control communities. The rate of buprenorphine prescribing among those waivered practitioners was also compared between the intervention and wait-list control communities. Intention-to-treat and per-protocol analyses were performed.ResultsA total of 8 211 506 individuals aged 18 years or older were residents of the 67 communities studied. There was no evidence of an effect of the CTH intervention on the adjusted rate of practitioners with a DATA 2000 waiver (adjusted relative rate [ARR], 1.04; 95% CI, 0.94-1.14) or the adjusted rate of practitioners with a DATA 2000 waiver who actively prescribed buprenorphine (ARR, 1.00; 95% CI, 0.91-1.10).Conclusions and RelevanceIn this randomized clinical trial, the CTH intervention was not associated with increases in the rate of practitioners with a DATA 2000 waiver or buprenorphine prescribing among those waivered practitioners. Supporting practitioners to prescribe buprenorphine remains a critical yet challenging step in the continuum of care to treat opioid use disorder.Trial RegistrationClinicalTrials.gov Identifier: NCT04111939

Publisher

American Medical Association (AMA)

Cited by 1 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

1. Errors in Definitions Used by Research Sites;JAMA Network Open;2024-08-19

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