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

在答复中我们感谢Desai等对我们的文章¹进行评论报告了美国海洛因使用和海洛因使用失调的趋势，并注意到他们的发现：尽管从2010年到2016年，马萨诸塞州通过增加ODM处方人数增加了使用阿片类药物依赖性药物（ODM）的机会，但阿片类药物相关的死亡率上升得更快。显然，增加可用的ODM处方者数量只是解决阿片类药物流行所必须解决的众多因素中的一种。我们同意Desai等人的观点，尽管接受ODM的受益者众多，但如果继续使用海洛因和其他阿片类药物（例如芬太尼，甚至更强的合成阿片类药物）的发生率和患病率，与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向其提供ODM的患者数量，因此，开处方者的增加并不一定意味着接受ODM的患者人数急剧增加。此外，由于耻辱感，不需要治疗的信念，或接受阿片类药物过量治疗后的结构障碍/可及性，只有少数阿片类药物使用障碍患者寻求治疗。²在那些人中，有很多人辍学了。³