School of Nursing and Health Professions, University of San Francisco, San Francisco, CA 94117, USA.
Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA 01003, USA.
Int J Environ Res Public Health. 2022 Jul 30;19(15):9346. doi: 10.3390/ijerph19159346.
Opioid-related fatalities increased exponentially during the COVID-19 pandemic and show little sign of abating. Despite decades of scientific evidence that sustained engagement with medications for opioid use disorders (MOUD) yields positive psychosocial outcomes, less than 30% of people with OUD engage in MOUD. Treatment rates are lowest for women. The aim of this project was to identify women-specific barriers and facilitators to treatment engagement, drawing from the lived experience of women in treatment. Data are provided from a parent study that used a community-partnered participatory research approach to adapt an evidence-based digital storytelling intervention for supporting continued MOUD treatment engagement. The parent study collected qualitative data between August and December 2018 from 20 women in Western Massachusetts who had received MOUD for at least 90 days. Using constructivist grounded theory, we identified major themes and selected illustrative quotations. Key barriers identified in this project include: (1) MOUD-specific discrimination encountered via social media, and in workplace and treatment/recovery settings; and (2) fear, perceptions, and experiences with MOUD, including mental health medication synergies, internalization of MOUD-related stigma, expectations of treatment duration, and opioid-specific mistrust of providers. Women identified two key facilitators to MOUD engagement: (1) feeling "safe" within treatment settings and (2) online communities as a source of positive reinforcement. We conclude with women-specific recommendations for research and interventions to improve MOUD engagement and provide human-centered care for this historically marginalized population.
阿片类药物相关死亡人数在 COVID-19 大流行期间呈指数级增长，且目前尚无减少迹象。尽管有几十年的科学证据表明，持续使用阿片类药物使用障碍（MOUD）药物治疗可产生积极的心理社会结果，但只有不到 30%的阿片类药物使用障碍患者接受 MOUD 治疗。女性的治疗率最低。本项目旨在从接受治疗的女性的生活经历中，确定针对女性的治疗参与障碍和促进因素。数据来自一项母研究，该研究采用社区伙伴参与式研究方法，对基于证据的数字故事干预措施进行了调整，以支持持续接受 MOUD 治疗。母研究于 2018 年 8 月至 12 月期间从马萨诸塞州西部的 20 名接受 MOUD 治疗至少 90 天的女性中收集了定性数据。使用建构主义扎根理论，我们确定了主要主题并选择了说明性引述。本项目确定的主要障碍包括：(1) 通过社交媒体以及工作场所和治疗/康复场所遇到的 MOUD 特定歧视；(2) 对 MOUD 的恐惧、认知和体验，包括精神健康药物协同作用、MOUD 相关耻辱感内化、对治疗持续时间的期望以及对提供者的特定阿片类药物不信任。女性确定了两个促进 MOUD 参与的关键因素：(1) 在治疗环境中感到“安全”；(2) 将在线社区作为积极强化的来源。我们最后为提高 MOUD 参与度和为这一历史上被边缘化的人群提供以人为本的护理提出了针对女性的具体建议。
