Buprenorphine Maintenance for Opioid Dependence in Public Sector Healthcare: Benefits and Barriers
Bibliographic record
Abstract
Background: Since its U.S. FDA approval in 2002, buprenorphine has been available for maintenance treatment of opiate dependence in primary care physicians' offices.Though buprenorphine was intended to facilitate access to treatment, disparities in utilization have emerged; while buprenorphine treatment is widely used in private care setting, public healthcare integration of buprenorphine lags behind.Results: Through a review of the literature, we found that U.S. disparities are partly due to a shortage of certified prescribers, concern of patient diversion, as well as economic and institutional barriers.Disparity of buprenorphine treatment dissemination is concerning since buprenorphine treatment has specific characteristics that are especially suited for low-income patient population in public sector healthcare such as flexible dosing schedules, ease of concurrently treating co-morbidities such as HIV and hepatitis C, positive patient attitudes towards treatment, and the potential of reducing addiction treatment stigma.Conclusion: As the gap between buprenorphine treatment in public sector settings and private sector settings persists in the U.S., current research suggests ways to facilitate its dissemination.largest opiate dependent population, confirmed higher prescription rates in high-income residential areas with low percentages of African American and Hispanic residents [11].Treatment rate disparities have been fueled by the focus of buprenorphine marketing on the private sector [12] and by the perception that office-based buprenorphine treatment is most appropriate for employed, and therefore "stable," patients [14,15].Buprenorphine has been increasingly prescribed by primary care physicians; primary care physicians compose 63.5% of buprenorphine maintenance treatment providers in 2013 [5].Despite an increase in buprenorphine maintenance providers, Stein et al found that 43% of U.S. counties have zero buprenorphine providers [15].Buprenorphine's comparable effectiveness to methadone in treating opioid addiction [16] and its tested suitability for varying therapeutic settings should be highlighted to promote implementation in public healthcare settings [17].Buprenorphine maintenance treatment has additional characteristics that make it useful in the public sector, such as: 1) enhanced accessibility due to multiple venues for treatment, 2) flexible dosing that requires less institutional oversight than methadone, 3) demonstrated effectiveness among populations that heavily rely on public healthcare systems, such as the formerly incarcerated, and the homeless, 4) the potential to treat comorbid chronic conditions prevalent among opiate dependent people such as HIV, and 5) the potential to lessen the stigma correlated with drug dependency among low income patients and ethnic minorities who already experience other forms of culturally defined social stigmatization [18,19].This accumulated data can be used to improve the accessibility of buprenorphine as a first line treatment for heroin and opioid dependence for patients in public clinics.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.027 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".