University of Kansas, School of Social Welfare, 1545 Lilac Lane, Lawrence, KS 66045, USA.
University of Kansas, School of Social Welfare, 1545 Lilac Lane, Lawrence, KS 66045, USA.
J Subst Abuse Treat. 2019 Sep;104:42-50. doi: 10.1016/j.jsat.2019.06.004. Epub 2019 Jun 7.
Medications for opioid use disorder (OUD) are associated with better overall outcomes for individuals managing their OUD. While much attention has focused on expanding access to these medications, this study aimed to gain further clarity on how facility-level characteristics may be contributing to availability of complementary recovery-oriented and/or recovery support services for individuals diagnosed with OUD. We created a census of 410 facilities located within a Midwestern metropolitan area that provided services aligning with the substance use disorder (SUD) continuum of care between September 2017 and March 2018. Among facilities serving individuals with opioid-related needs (N = 360), we triangulated five sources of data to measure facility-reported acceptance for individuals who are using medications for OUD. We also obtained facility rationale for their acceptance level (N = 89). We used multinomial logistic regression to identify facility-level factors associated with acceptance for medication use, and we used content analysis to identify categories of common rationales. Compared to moderate acceptance facilities, zero and low acceptance facilities were more likely to provide recovery support services or less likely to provide more than one type of SUD service. In contrast, high acceptance facilities were more likely than moderate acceptance facilities to focus primarily on mental health needs or provide multiple types of SUD services. Qualitative feedback suggests that the factors contributing to these relationships are complex and varied, providing multiple points for intervention at a facility level to increase service availability for individuals using medications for OUD. We address implications for policy and practice, highlighting the need to build an infrastructure that promotes availability of complementary recovery-oriented and recovery support service for individuals once they are prescribed medications for OUD.
用于治疗阿片类药物使用障碍（OUD）的药物与改善接受 OUD 治疗的个体的整体结果相关。尽管人们非常关注扩大这些药物的可及性，但本研究旨在更深入地了解设施层面的特征如何有助于为被诊断为 OUD 的个体提供补充以康复为导向的和/或康复支持服务。我们创建了一个位于中西部大都市区内的 410 个提供与物质使用障碍（SUD）连续护理服务相匹配的设施的普查，时间为 2017 年 9 月至 2018 年 3 月。在为有阿片类相关需求的个体提供服务的设施中（N=360），我们通过三角测量了五种数据来源来衡量设施报告的对使用 OUD 药物的个体的接受程度。我们还获得了设施接受水平的理由（N=89）。我们使用多项逻辑回归来确定与药物使用接受度相关的设施层面因素，并使用内容分析来确定常见理由的类别。与中度接受度的设施相比，零接受度和低接受度的设施更有可能提供康复支持服务，或不太可能提供超过一种 SUD 服务。相比之下，高接受度的设施比中度接受度的设施更有可能主要关注心理健康需求或提供多种 SUD 服务。定性反馈表明，导致这些关系的因素是复杂多样的，为在设施层面增加为使用 OUD 药物的个体提供服务的可及性提供了多个干预点。我们探讨了政策和实践的影响，强调需要建立一个基础设施，以促进为开出 OUD 药物的个体提供补充以康复为导向的和康复支持服务。
