Magee Women's Research Institute, Department of Obstetrics, Gynecology, and Reproductive Sciences, and Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Duquesne University, Pittsburgh, Pennsylvania, USA.
Subst Abus. 2021;42(4):888-895. doi: 10.1080/08897077.2021.1891601. Epub 2021 Mar 9.
Certain communities in the United States experience greater opioid-involved overdose mortality than others. Interventions to stem overdose benefit from contextual understandings of communities' needs and strengths in addressing the opioid crisis. This project aims to understand multiple stakeholder perspectives on the opioid epidemic in communities disproportionately affected by opioid-involved overdose mortality. We performed a rapid-cycle qualitative assessment study utilizing in-depth interviews with community stakeholders and observations of community meetings in eight communities in Allegheny County, Pennsylvania, USA, disproportionately impacted by opioid-involved overdose mortality. Stakeholder categories included: current and past illicit users of opioids; medical and social service providers; emergency medical services; law enforcement; spouse or other family members of illicit users/former users of opioids; government officials; school officials; community members. Content analysis was utilized to identify themes and answer study questions. Regular feedback to stakeholders was provided to support targeted interventions. We performed semi-structured, in-depth interviews with 130 community stakeholders and 29 community meeting observations in 2018-2019. Participants perceived similar economic and social determinants as origins of the opioid overdose epidemic including lack of economic resources, loss of jobs, transient populations and dilapidated housing. However, they differed in their awareness of and attention to the epidemic. Awareness was dependent on the visibility of opioid use (presence of paraphernalia litter, location of drug users, media coverage, and relationship to users). Overall, there was good knowledge of naloxone for opioid overdose reversal but less knowledge about local syringe services programs. Perceptions of harm reduction efforts were ambivalent. Members of communities impacted by the opioid epidemic perceived that economic downturn was a major factor in the opioid overdose epidemic. However, the varied beliefs within and between communities suggest that interventions need to be tailored according to the cultural norms of place.
美国某些社区的阿片类药物过量死亡率高于其他社区。为了遏制过量用药，干预措施需要了解社区在应对阿片类药物危机方面的需求和优势。本项目旨在了解受阿片类药物过量死亡率不成比例影响的社区中，多个利益相关者对阿片类药物流行的看法。我们在美国宾夕法尼亚州阿勒格尼县的八个社区中进行了一项快速循环定性评估研究，利用社区利益相关者的深入访谈和社区会议观察，这些社区受到阿片类药物过量死亡率的不成比例影响。利益相关者类别包括：目前和过去的阿片类药物非法使用者；医疗和社会服务提供者；紧急医疗服务人员；执法人员；阿片类药物非法使用者/前使用者的配偶或其他家庭成员；政府官员；学校官员；社区成员。我们利用内容分析来确定主题并回答研究问题。向利益相关者提供定期反馈，以支持有针对性的干预措施。我们在 2018 年至 2019 年期间进行了半结构式深入访谈，共采访了 130 名社区利益相关者和 29 次社区会议观察。参与者认为，导致阿片类药物过量流行的经济和社会决定因素相似，包括缺乏经济资源、失业、流动人口和破旧的住房。然而，他们对疫情的认识和关注程度不同。意识取决于阿片类药物使用的可见性（存在吸毒用具、吸毒者的位置、媒体报道以及与使用者的关系）。总体而言，对于纳洛酮逆转阿片类药物过量的知识较好，但对于当地注射器服务项目的了解较少。对减少伤害措施的看法存在矛盾。受阿片类药物流行影响的社区成员认为经济下滑是阿片类药物过量流行的一个主要因素。然而，社区内部和之间的信仰差异表明，干预措施需要根据地方文化规范进行定制。
