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Int J Drug Policy. 2019 Feb 11. pii: S0955-3959(19)30028-3. doi: 10.1016/j.drugpo.2019.01.020. [Epub ahead of print]

Comparing Canadian and United States opioid agonist therapy policies.

Author information

1
Oregon Health & Science University (OHSU) and Portland State University School of Public Health, Portland, OR, 97239, USA; MD/PhD Program, School of Medicine, OHSU, Portland, OR, 97239, USA. Electronic address: priest@ohsu.edu.
2
British Columbia Centre on Substance Use, University of British Columbia (UBC), Vancouver, BC, V6Z 1Y6, Canada; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, 10032, USA.
3
British Columbia Centre on Substance Use, University of British Columbia (UBC), Vancouver, BC, V6Z 1Y6, Canada.
4
Department of Psychiatry, UBC, Vancouver, BC, V6Z 1Y6, Canada.
5
British Columbia Centre on Substance Use, University of British Columbia (UBC), Vancouver, BC, V6Z 1Y6, Canada; Department of Medicine, UBC, Vancouver, BC, V6Z 1Y6, Canada.
6
Oregon Health & Science University (OHSU) and Portland State University School of Public Health, Portland, OR, 97239, USA; Department of Psychiatry, School of Medicine, OHSU, Portland, OR, 97239, USA.

Abstract

Canada and the United States (U.S.) face an opioid use disorder (OUD) and opioid overdose epidemic. The most effective OUD treatment is opioid agonist therapy (OAT)-buprenorphine (with and without naloxone) and methadone. Although federal approval for OAT occurred decades ago, in both countries, access to and use of OAT is low. Restrictive policies and complex regulations contribute to limited OAT access. Through a non-systematic literature scan and a review of publicly available policy documents, we examined and compared OAT policies and practice at the federal (Canada vs. U.S.) and local levels (British Columbia [B.C.] vs. Oregon). Differences and similarities were noted between federal and local OAT policies, and subsequently OAT access. In Canada, OAT policy control has shifted from federal to provincial authorities. Conversely, in the U.S., federal authorities maintain primary control of OAT regulations. Local OAT health insurance coverage policies were substantively different between B.C. and Oregon. In B.C., five OAT options were available, while in Oregon, only two OAT options were available with administrative limitations. The differences in local OAT access and coverage policies between B.C. and Oregon, may be explained, in part, to the differences in Canadian and U.S. federal OAT policies, specifically, the relaxation of special federal OAT regulatory controls in Canada. The analysis also highlights the complicating contributions, and likely policy solutions, that exist within other drug policy sub-domains (e.g., the prescription regime, and drug control regime) and broader policy domains (e.g., constitutional rights). U.S. policymakers and health officials could consider adopting Canada's regulatory policy approach to expand OAT access to mitigate the harms of the ongoing opioid overdose epidemic.

KEYWORDS:

Buprenorphine; Drug policy; Methadone; Opioid agonist therapy; Opioid use disorder; buprenorphine/naloxone

PMID:
30765118
PMCID:
PMC6689455
[Available on 2020-08-11]
DOI:
10.1016/j.drugpo.2019.01.020

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