Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Road (MPD-152), Menlo Park, Willow, CA, 94025, USA.
Department of Veterans Affairs, National Center on Homelessness Among Veterans, 795 Willow Road, Menlo Park, 94025, USA.
J Gen Intern Med. 2020 Sep;35(9):2529-2536. doi: 10.1007/s11606-020-05944-6. Epub 2020 Jun 24.
Veterans involved in the legal system are at high risk for overdose but have lower receipt of medications for opioid use disorder than other veterans.
The study aimed to understand barriers to medication access from the perspective of legally involved veterans with opioid use disorder and people who work with these veterans in the Veterans Health Administration (VHA) and the legal system.
This national qualitative study interviewed veterans and stakeholders from 14 geographically diverse VHA facilities to explore perceptions of barriers to medications for opioid use disorder.
Participants included veterans with a history of opioid use disorder and legal involvement (n = 18), VHA Veterans Justice Programs Specialists (n = 15), VHA and community substance use disorder treatment providers (n = 5), and criminal justice staff (n = 12).
We conducted interviews based on the Consolidated Framework for Implementation Research. Interview transcripts were analyzed using a team-based approach.
Four key barriers, noted by group, were identified: (1) a preference for counseling along with or instead of medications (veterans, Specialists, treatment providers, criminal justice staff); (2) concerns about veterans using medications without a prescription, selling them, or providing them to others (veterans, Specialists, treatment providers, criminal justice staff); (3) concerns about perceived stigma towards medication use (veterans, Specialists, treatment providers, criminal justice staff); and (4) concerns about medication discontinuation after recurrent opioid use (veterans, criminal justice staff). A fifth theme, education, was noted by all stakeholders except providers as important to facilitating use of medications for opioid use disorder. All five themes mapped to the framework construct of knowledge and beliefs about the intervention.
Based on identified barriers, interventions focused on enhancing medication knowledge, reducing stigma towards use of medications, and increasing knowledge that opioid use may recur during treatment may help increase access to medication for veterans with legal involvement.
参与法律体系的退伍军人有很高的药物过量风险，但与其他退伍军人相比，他们获得阿片类药物使用障碍治疗药物的机会较低。
本研究旨在从有阿片类药物使用障碍且涉及法律问题的退伍军人以及在退伍军人健康管理局（VHA）和法律系统中为这些退伍军人提供服务的人员的角度了解获取药物的障碍。
这项全国性的定性研究采访了来自 14 个地理位置不同的 VHA 设施的退伍军人和利益相关者，以探讨他们对阿片类药物使用障碍治疗药物的看法。
参与者包括有阿片类药物使用障碍和法律问题历史的退伍军人（n=18）、VHA 退伍军人司法项目专家（n=15）、VHA 和社区药物滥用治疗提供者（n=5）以及刑事司法工作人员（n=12）。
我们根据综合实施研究框架进行了采访。采用团队方法对采访记录进行了分析。
根据小组意见确定了四个关键障碍：（1）偏爱咨询而不是药物治疗（退伍军人、专家、治疗提供者、刑事司法工作人员）；（2）担心退伍军人未经处方使用药物、转卖药物或向他人提供药物（退伍军人、专家、治疗提供者、刑事司法工作人员）；（3）担心人们对药物使用的看法存在污名化（退伍军人、专家、治疗提供者、刑事司法工作人员）；（4）担心在复发性阿片类药物使用后停药（退伍军人、刑事司法工作人员）。除提供者外，所有利益相关者都提到第五个主题，即教育，这对于促进阿片类药物使用障碍药物的使用非常重要。所有五个主题都与干预措施的知识和信念框架结构相对应。
根据确定的障碍，干预措施重点是增强对药物的认识，减少对药物使用的污名化，并增加对治疗期间可能再次出现阿片类药物使用的认识，这可能有助于增加有法律问题的退伍军人获得药物的机会。
