“在停止使用任何药物之前，你都不算戒毒成功”：阿巴拉契亚农村地区对药物辅助治疗的认知
"You are not clean until you're not on anything": Perceptions of medication-assisted treatment in rural Appalachia.
作者信息
Richard Emma L, Schalkoff Christine A, Piscalko Hannah M, Brook Daniel L, Sibley Adams L, Lancaster Kathryn E, Miller William C, Go Vivian F
机构信息
Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA.
Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
出版信息
Int J Drug Policy. 2020 Nov;85:102704. doi: 10.1016/j.drugpo.2020.102704. Epub 2020 Mar 12.
BACKGROUND
Medication-assisted treatment (MAT) is an evidence-based strategy to treat opioid use disorder (OUD). However, MAT-related stigma reduces MAT uptake, which is particularly low in rural areas. To date, perceptions and attitudes towards MAT in rural settings have not been described.
OBJECTIVE
This qualitative study aims to characterize perceptions and attitudes towards MAT and the environmental factors contributing to these views in Appalachian Ohio.
METHODS
From February to July 2018, semi-structured interviews were conducted with 34 stakeholders (12 healthcare professionals, 12 substance use treatment providers, 7 law enforcement agents and judicial officials, and 3 members of relevant organizations) in three rural counties in Appalachian Ohio. Interviews were transcribed, coded, and analyzed to characterize the risk environment and participants' perceptions and attitudes towards MAT.
RESULTS
Participants expressed or described pervasive MAT-related stigma in the region. Participants consistently described three elements of the environment affecting stigma: (1) a "conservative" culture in which abstinence is necessary to be in recovery successfully, (2) fear of medication diversion and abuse, and (3) drug court policies that keep MAT out of the criminal justice system.
CONCLUSION
MAT-related stigma will need to be addressed to tackle the opioid epidemic through evidence-based treatment effectively.
背景
药物辅助治疗（MAT）是一种基于证据的治疗阿片类物质使用障碍（OUD）的策略。然而，与MAT相关的污名化降低了MAT的采用率，在农村地区尤其低。迄今为止，农村地区对MAT的看法和态度尚未得到描述。
目的
这项定性研究旨在描述俄亥俄州阿巴拉契亚地区对MAT的看法和态度以及促成这些观点的环境因素。
方法
2018年2月至7月，对俄亥俄州阿巴拉契亚地区三个农村县的34名利益相关者（12名医疗保健专业人员、12名物质使用治疗提供者、7名执法人员和司法官员以及3名相关组织成员）进行了半结构化访谈。对访谈内容进行转录、编码和分析，以描述风险环境以及参与者对MAT的看法和态度。
结果
参与者表达或描述了该地区普遍存在的与MAT相关的污名化。参与者一致描述了影响污名化的环境的三个要素：（1）一种“保守”文化，即成功康复必须禁欲；（2）对药物转移和滥用的恐惧；（3）使MAT被排除在刑事司法系统之外的毒品法庭政策。
结论
需要解决与MAT相关的污名化问题，以便通过循证治疗有效应对阿片类药物流行。
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