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Perceptions of stimulant and buprenorphine diversion and strategies to address it.
Uscher-Pines, Lori; Sousa, Jessica; Raja, Pushpa; Mehrotra, Ateev; Busch, Alisa B; Huskamp, Haiden A.
Afiliación
  • Uscher-Pines L; RAND Corporation, Arlington, VA, 22202, United States.
  • Sousa J; RAND Corporation, Boston, MA, 02116, United States.
  • Raja P; Department of Mental Health, Greater Los Angeles VA Medical Center, Los Angeles, CA 90073, United States.
  • Mehrotra A; Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, United States.
  • Busch AB; Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States.
  • Huskamp HA; Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, United States.
Health Aff Sch ; 2(6): qxae074, 2024 Jun.
Article en En | MEDLINE | ID: mdl-38934014
ABSTRACT
There is ongoing policy debate on the prescribing of controlled substances such as buprenorphine and stimulants via telemedicine. The goal of federal and state policymakers is to ensure access to care while limiting diversion risk. However, there is little evidence on how clinicians view and address diversion and on telemedicine's role in diversion. From December 2023 to January 2024, we conducted semi-structured interviews with 21 psychiatrists and primary care physicians engaged in hybrid (telemedicine and in-person) care models in which we explored perceptions of diversion and strategies used to monitor for diversion. Most physicians reported monitoring for diversion, but there was little consistency on how monitoring was done and reported strategies did not differ between telemedicine vs in-person care. When physicians suspected diversion, there was also wide variation in responses some clinicians did not immediately take any action while others imposed more requirements on patients (e.g., more frequent visits), no longer prescribed the controlled substance, or terminated the patient from their practice. Few physicians had ever reported a case of suspected diversion to law enforcement. Our findings suggest that the Drug Enforcement Administration could clarify reporting requirements and professional societies could provide additional guidance on how to respond to suspected diversion, given the current variation in practice across clinicians could be exploited by individuals who want to divert.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Health Aff Sch Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Reino Unido

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Health Aff Sch Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Reino Unido