Washington Heights CORNER Project, New York, New York, USA.
Division of General Internal Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA.
Subst Abus. 2021;42(4):983-989. doi: 10.1080/08897077.2021.1901173. Epub 2021 Mar 24.
Syringe services programs (SSPs) complement substance use disorder treatment in providing services that improve the health of people who use drugs (PWUD). Buprenorphine treatment is an effective underutilized opioid use disorder treatment. Regulations allow buprenorphine prescribing from office-based settings, potentially including SSPs although few studies have examined this approach. Our objective was to assess the attitudes among PWUD toward the potential introduction of buprenorphine treatment in an SSP. : In this qualitative study, we recruited 34 participants who were enrolled at a New York City-based SSP to participate in one of seven focus group sessions. The focus group facilitators prompted participants to share their thoughts in five domains: attitudes toward (1) medical clinics; (2) harm reduction in general; (3) SSP-based buprenorphine treatment; (4) potential challenges of SSP-based treatment; and (5) logistical considerations of an SSP-based buprenorphine treatment program. Four researchers analyzed focus group transcripts using thematic analysis. : Of the 34 participants, most were white (68%), over the age of 40 years old (56%), and had previously tried buprenorphine (89%). Common themes were: 1) The SSP is a supportive community for people who use drugs; 2) Participants felt less stigmatized at the SSP than in general medical settings; 3) Offering buprenorphine treatment could change the SSP's culture; and 4) SSP participants receiving buprenorphine may be tempted to divert their medication. Participants offered suggestions for a slow intentional introduction of buprenorphine treatment at the SSP including structured appointments, training medical providers in harm reduction, and program eligibility criteria. : Overall, participants expressed enthusiasm for onsite buprenorphine treatment at SSPs. Research on SSP-based buprenorphine treatment should investigate standard buprenorphine treatment outcomes but also any effects on the program itself and medication diversion. Implementation should consider cultural and environmental aspects of the SSP and consult program staff and participants.
美沙酮维持治疗计划（SSP）通过提供改善吸毒者（PWUD）健康的服务，补充了物质使用障碍的治疗。丁丙诺啡治疗是一种有效的未充分利用的阿片类药物使用障碍治疗方法。法规允许在基于办公室的环境中开具丁丙诺啡处方，包括 SSP，但很少有研究探讨这种方法。我们的目的是评估 PWUD 对在 SSP 中引入丁丙诺啡治疗的潜在态度。
在这项定性研究中，我们招募了 34 名在纽约市的 SSP 登记的参与者，让他们参加了七个焦点小组中的一个。焦点小组的主持人促使参与者在五个领域分享他们的想法：（1）对医疗诊所的态度；（2）一般的减少伤害；（3）基于 SSP 的丁丙诺啡治疗；（4）基于 SSP 的治疗的潜在挑战；（5）基于 SSP 的丁丙诺啡治疗计划的后勤考虑。四名研究人员使用主题分析对焦点小组的记录进行了分析。
在 34 名参与者中，大多数是白人（68%），年龄超过 40 岁（56%），并且曾经尝试过丁丙诺啡（89%）。常见的主题包括：1）SSP 是吸毒者的一个支持性社区；2）参与者在 SSP 比在一般医疗环境中感到的耻辱感更少；3）提供丁丙诺啡治疗可能会改变 SSP 的文化；4）在 SSP 接受丁丙诺啡治疗的参与者可能会被诱惑将药物转移。参与者提出了在 SSP 中缓慢而有意地引入丁丙诺啡治疗的建议，包括结构化预约、对减少伤害的医疗服务提供者进行培训，以及项目资格标准。
总体而言，参与者对 SSP 中提供的丁丙诺啡治疗表示了热情。关于 SSP 中基于丁丙诺啡的治疗的研究应该调查标准丁丙诺啡治疗结果，但也要调查对项目本身和药物转移的任何影响。实施应考虑 SSP 的文化和环境方面，并咨询项目工作人员和参与者。
