Objectives. To evaluate changes in monthly buprenorphine dispensation associated with federal prescribing policies in Washington State from 2012 to 2022.

Methods. We conducted an interrupted time series analysis comparing monthly buprenorphine prescriptions dispensed per 1000 population after the Comprehensive Addiction and Recovery Act (CARA), Substance Use-Disorder Prevention That Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT), and new prescribing rules during the COVID-19 pandemic. Buprenorphine formulated for opioid use disorder was included from the Washington State Prescription Monitoring Program. A log-linear autoregressive model measured linear trend changes.

Results. Physician prescribing increased by 1.63% (95% confidence interval [CI] = 1.41%, 1.85%) per month after CARA with sustained declines after SUPPORT. Nurse practitioner (NP) prescribing increased by 19.48% (95% CI = 18.8%, 20.16%) per month after CARA with physician assistants (PAs) showing similar trends. Following the implementation of SUPPORT, NP and PA trends continued to increase at a reduced growth rate of 3.96% (95% CI = 2.01%, 5.94%) and 1.87% (95% CI = 0.56%, 3.19%), respectively. No prescribers experienced increases during the COVID-19 pandemic.

Conclusions. CARA nearly tripled the buprenorphine prescribing rate. The SUPPORT Act initiated sustained declines for physician prescribing, and the COVID-19 period reversed gains for PAs and NPs. The current opioid crisis requires expanded efforts in Washington State. (Am J Public Health. Published online ahead of print May 2, 2024:e1–e9. https://doi.org/10.2105/AJPH.2024.307649)

目标。评估 2012 年至 2022 年华盛顿州每月丁丙诺啡配药量与联邦处方政策相关的变化。

方法。我们进行了一项中断时间序列分析，比较了综合成瘾和康复法案 (CARA)、促进阿片类药物康复和患者和社区治疗的药物使用障碍预防法案 (SUPPORT) 以及新处方规则之后每 1000 人每月发放的丁丙诺啡处方情况在 COVID-19 大流行期间。为阿片类药物使用障碍配制的丁丙诺啡包含在华盛顿州处方监测计划中。对数线性自回归模型测量线性趋势变化。

结果。 CARA 后每月医生处方增加 1.63%（95% 置信区间 [CI] = 1.41%, 1.85%），SUPPORT 后持续下降。 CARA 后，执业护士 (NP) 的处方每月增加 19.48% (95% CI = 18.8%, 20.16%)，医师助理 (PA) 也显示出类似的趋势。实施 SUPPORT 后，NP 和 PA 趋势继续增加，增长率分别为 3.96%（95% CI = 2.01%、5.94%）和 1.87%（95% CI = 0.56%、3.19%）。在 COVID-19 大流行期间，没有处方医生出现药物用量增加的情况。

结论。 CARA 的丁丙诺啡处方率几乎增加了两倍。 《支持法案》导致医生处方量持续下降，而 COVID-19 时期则逆转了 PA 和 NP 的增长。当前的阿片类药物危机需要华盛顿州加大力度。 （《Am J Public Health》。2024 年 5 月 2 日印刷前在线发布：e1–e9。https://doi.org/10.2105/AJPH.2024.307649）