Taylor Jirka, Ober Allison J, Kilmer Beau, Caulkins Jonathan P, Iguchi Martin Y
Drug Policy Research Center, RAND Corporation, 1200 South Hayes Street, Arlington, VA 22202, United States of America.
Drug Policy Research Center, RAND Corporation, 1776 Main St., Santa Monica, CA 90407, United States of America.
J Subst Abuse Treat. 2021 Dec;131:108397. doi: 10.1016/j.jsat.2021.108397. Epub 2021 Apr 20.
To address the overdose crisis in the United States, expert groups have been nearly unanimous in calls for increasing access to evidence-based treatment and overdose reversal drugs. In some places there have also been calls for implementing supervised consumption sites (SCSs). Some cities-primarily in coastal urban areas-have explored the feasibility and acceptability of introducing them. However, the perspectives of community stakeholders from more inland and rural areas that have also been hard hit by opioids are largely missing from the literature.
To examine community attitudes about implementing SCSs for people who use opioids (PWUO) in areas with acute opioid problems, the research team conducted in-depth interviews and focus groups in four counties: Ashtabula and Cuyahoga Counties in Ohio, and Carroll and Hillsborough Counties in New Hampshire, two states with high rates of opioid overdose. Participants were policy, treatment, and criminal justice professionals, frontline harm reduction and service providers, and PWUO.
Key informants noted benefits to SCSs, but also perceived potential drawbacks such as that they may enable opioid use, and potential practical barriers, including lack of desire among PWUO to travel to an SCS after purchasing opioids and fear of arrest. Key informants generally believed their communities likely would not currently accept SCSs due to cultural, resource, and practical barriers. They viewed publication of evidence on SCSs and community education as essential for fostering acceptance.
Despite cultural and other barriers, implementation of SCSs may be more feasible in urban communities with existing (and perhaps more long-standing) harm reduction programs, greater treatment resources, and adequate transportation, particularly if there is strong evidence to support them.
为应对美国的药物过量危机，专家小组几乎一致呼吁增加循证治疗和过量用药逆转药物的可及性。在一些地方，也有人呼吁设立监督下的消费场所（SCS）。一些城市——主要是沿海城市地区——已探讨了引入这些场所的可行性和可接受性。然而，文献中基本没有涉及受阿片类药物影响也很严重的更多内陆和农村地区社区利益相关者的观点。
为了研究在存在急性阿片类药物问题的地区针对使用阿片类药物者（PWUO）实施SCS的社区态度，研究团队在四个县进行了深入访谈和焦点小组讨论：俄亥俄州的阿什塔比拉县和凯霍加县，以及新罕布什尔州的卡罗尔县和希尔斯伯勒县，这两个州的阿片类药物过量使用率很高。参与者包括政策、治疗和刑事司法专业人员、一线减少伤害和服务提供者以及PWUO。
关键信息提供者指出了SCS的好处，但也意识到了潜在的缺点，比如它们可能会助长阿片类药物的使用，以及潜在的实际障碍，包括PWUO在购买阿片类药物后不愿前往SCS以及对被捕的恐惧。关键信息提供者普遍认为，由于文化、资源和实际障碍，他们所在的社区目前可能不会接受SCS。他们认为公布有关SCS的证据和开展社区教育对于促进接受度至关重要。
尽管存在文化和其他障碍，但在已有（可能也是更长期的）减少伤害项目、更多治疗资源和充足交通的城市社区，实施SCS可能更可行，特别是如果有强有力的证据支持的话。
