Harvard College, Massachusetts Hall, Cambridge, MA, 02138, United States.
Harvard College, Massachusetts Hall, Cambridge, MA, 02138, United States.
Drug Alcohol Depend. 2021 Jul 1;224:108717. doi: 10.1016/j.drugalcdep.2021.108717. Epub 2021 Apr 20.
The opioid-related overdose epidemic remains a persistent public health problem in the United States and has been accelerated by the 2019 coronavirus disease pandemic. Existing, evidence-based treatment options for opioid use disorder (OUD) are broadly underutilized, particularly by people experiencing homelessness (PEH). PEH are also more likely to misuse and overdose on opioids. To better understand current gaps and disparities in OUD treatment experienced by PEH and efforts to address them, we synthesized the literature reporting on the intersection of housing status and OUD treatment.
We conducted a scoping review of the literature from the electronic databases MEDLINE, Embase, PsycINFO, and Web of Science Core Collection. We included studies describing treatment-related outcomes specific to PEH and articles assessing OUD treatment interventions tailored to this population. Relevant findings were compiled via thematic analysis and narratively synthesized.
60 articles met our inclusion criteria, including 43 descriptive and 17 intervention-focused studies. These studies demonstrated that PEH experience more barriers to OUD treatment than their housed counterparts and access inpatient and detoxification treatment more commonly than pharmacotherapy. However, the reviewed literature indicated that PEH have similar outcomes once engaged in pharmacotherapy. Efficacious interventions for PEH were low-barrier and targeted, with housing interventions also demonstrating benefit.
PEH have diminished access to evidence-based OUD treatment, particularly medications, and require targeted approaches to improve engagement and retention. To mitigate the disproportionate opioid-related morbidity and mortality PEH experience, innovative, flexible, and interdisciplinary OUD treatment models are necessary, with housing support playing an important role.
阿片类药物相关的过量用药在美国仍是一个持续存在的公共卫生问题，且在 2019 年冠状病毒病大流行的推动下愈演愈烈。现有的、基于证据的阿片类药物使用障碍（OUD）治疗方案广泛未得到充分利用，尤其是无家可归者（PEH）。PEH 也更有可能滥用和过量使用阿片类药物。为了更好地了解 PEH 经历的 OUD 治疗中当前的差距和差异，以及为解决这些问题所做的努力，我们综合了报告住房状况和 OUD 治疗交叉点的文献。
我们对电子数据库 MEDLINE、Embase、PsycINFO 和 Web of Science Core Collection 中的文献进行了范围综述。我们纳入了描述特定于 PEH 的治疗相关结果的研究，以及评估针对该人群的 OUD 治疗干预措施的文章。通过主题分析和叙述性综合收集相关发现。
有 60 篇文章符合我们的纳入标准，包括 43 篇描述性研究和 17 篇干预性研究。这些研究表明，PEH 经历的 OUD 治疗障碍多于有住房的同龄人，更常见于接受住院和戒毒治疗，而非药物治疗。然而，综述文献表明，PEH 一旦接受药物治疗，其结果相似。针对 PEH 的有效干预措施具有低障碍性和针对性，住房干预也显示出益处。
PEH 获得基于证据的 OUD 治疗的机会较少，特别是药物治疗，需要采取针对性的方法来提高他们的参与度和保留率。为了减轻 PEH 经历的不成比例的阿片类相关发病率和死亡率，需要创新、灵活和跨学科的 OUD 治疗模式，住房支持发挥着重要作用。
