In Reply We thank Desai et al for commenting on our article¹ reporting trends in heroin use and heroin use disorder in the United States and for noting their findings that while access to opioid-dependency medication (ODM) increased in Massachusetts from 2010 to 2016 through greater numbers of ODM prescribers, opioid-related deaths rose even faster. Clearly, increasing the number of available ODM prescribers is only 1 of many factors that must be addressed to solve the opioid epidemic. We agree with Desai et al that despite the benefits of ODM among those receiving it, rates of opioid-related deaths are not likely to decrease if the incidence and prevalence of heroin use and other opioids (eg, fentanyl and even stronger synthetic opioids) continue to rise. Further, we note that prescribers are usually limited in the number of patients to whom they can offer ODM, so an increase in prescribers does not necessarily translate into a sharp increase in the number of patients receiving ODM. Moreover, only a minority of patients with opioid use disorder seek treatment because of stigma, beliefs that they do not need treatment, or structural barriers/accessibility to seek treatment after being treated for an opioid overdose.² Of those who do, many drop out.³

在回复中，我们感谢 Desai 等人对我们的文章^{1发表评论}报告了美国海洛因使用和海洛因使用障碍的趋势，并注意到他们的发现，虽然从 2010 年到 2016 年马萨诸塞州通过更多的 ODM 处方者获得阿片类药物依赖药物 (ODM) 的机会有所增加，但与阿片类药物相关的死亡人数上升得更快. 显然，增加可用的 ODM 处方者的数量只是解决阿片类药物流行病必须解决的众多因素之一。我们同意 Desai 等人的观点，尽管 ODM 对接受它的人有好处，但如果海洛因和其他阿片类药物（例如芬太尼和更强的合成阿片类药物）的发生率和流行率继续下去，阿片类药物相关的死亡率不太可能降低上升。此外，我们注意到开处方者通常会限制他们可以提供 ODM 的患者数量，因此，开处方者的增加并不一定会转化为接受 ODM 的患者数量的急剧增加。此外，只有少数患有阿片类药物使用障碍的患者会因为耻辱感、认为他们不需要治疗或结构性障碍/在接受阿片类药物过量治疗后寻求治疗的可及性而寻求治疗。²在这样做的人中，许多人辍学了。^3个