Comparing Canadian and United States opioid agonist therapy policies

Kelsey C. Priest, Lauren Gorfinkel, Jan Klimas, Andrea A. Jones, Nadia Fairbairn, Dennis McCarty

Research output: Contribution to journalArticle

1 Citation (Scopus)

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.

Original languageEnglish (US)
JournalInternational Journal of Drug Policy
DOIs
StatePublished - Jan 1 2019

Fingerprint

Opioid Analgesics
Therapeutics
British Columbia
Canada
Buprenorphine
Insurance Coverage
Prescription Drugs
Drug and Narcotic Control
Methadone
Health Insurance
Naloxone

Keywords

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

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Health Policy

Cite this

Comparing Canadian and United States opioid agonist therapy policies. / Priest, Kelsey C.; Gorfinkel, Lauren; Klimas, Jan; Jones, Andrea A.; Fairbairn, Nadia; McCarty, Dennis.

In: International Journal of Drug Policy, 01.01.2019.

Research output: Contribution to journalArticle

Priest, Kelsey C. ; Gorfinkel, Lauren ; Klimas, Jan ; Jones, Andrea A. ; Fairbairn, Nadia ; McCarty, Dennis. / Comparing Canadian and United States opioid agonist therapy policies. In: International Journal of Drug Policy. 2019.
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