Department of Psychology, University of Maryland at College Park, College Park, MD, USA.
Department of Psychology, University of Maryland at College Park, College Park, MD, USA.
J Subst Use Addict Treat. 2023 Jun;149:209046. doi: 10.1016/j.josat.2023.209046. Epub 2023 Apr 14.
Successful engagement with medication treatment for opioid use disorder is an important focus in reducing mortality associated with the opioid crisis. Mortality remains at unacceptably high levels, pointing to a need for improved understanding of factors that affect medication for opioid use disorder outcomes. This study aims to understand how barriers co-occur and interact to interfere with outcomes in methadone treatment for a low-income, underserved patient population with opioid use disorder.
This study was conducted at a community-based drug treatment center that serves a predominately low-income, racially diverse population. Guided by the social-ecological framework, we analyzed semi-structured interviews and focus groups with patients and providers working in opioid use disorder care and recovery across Baltimore City (N = 32) to assess factors that influence methadone treatment outcomes, and how barriers co-occur and interact to worsen treatment outcomes. The study used patient-centered definitions to describe successful treatment outcomes.
Barriers described by both patients and providers fit into several broad levels: individual, interpersonal, institutional, community, and stigma. Participants described co-occurrence of many barriers. Further, the study identified potential interactive effects, such that interrelated barriers were seen as fueling one another and having a deleterious effect on treatment outcomes. Specifically, interrelationships between barriers were described for 1) unstable housing with social influences and mental health factors; 2) transportation with poor physical health and other competing responsibilities; 3) treatment program policies and schedule with competing responsibilities; and 4) stigma with poor physical and mental health.
Understanding barriers to successful medication for opioid use disorder outcomes and considering their co-occurrence may help to identify and promote interventions to mitigate their impact. This work is intended to guide future research to adapt conceptual frameworks for understanding psychosocial and structural barriers affecting opioid use disorder treatment and ultimately intervention efforts to improve treatment outcomes.
成功参与阿片类药物使用障碍的药物治疗是降低与阿片类药物危机相关死亡率的重要重点。死亡率仍然居高不下，这表明需要更好地了解影响阿片类药物使用障碍药物治疗结果的因素。本研究旨在了解在为患有阿片类药物使用障碍的低收入、服务不足的患者群体提供的美沙酮治疗中，障碍如何共同发生和相互作用，从而干扰治疗结果。
本研究在一家社区毒品治疗中心进行，该中心主要为低收入、种族多样化的人群提供服务。本研究以社会生态学框架为指导，分析了巴尔的摩市（N=32）从事阿片类药物使用障碍护理和康复工作的患者和提供者的半结构化访谈和焦点小组，以评估影响美沙酮治疗结果的因素，以及障碍如何共同发生和相互作用，从而恶化治疗结果。该研究使用以患者为中心的定义来描述成功的治疗结果。
患者和提供者描述的障碍分为几个广泛的层面：个人、人际、机构、社区和耻辱感。参与者描述了许多障碍的共同发生。此外，该研究还发现了潜在的交互效应，即相互关联的障碍被视为相互助长，并对治疗结果产生有害影响。具体而言，障碍之间的相互关系包括：1）不稳定的住房与社会影响和心理健康因素；2）交通与身体不好和其他竞争责任；3）治疗计划政策和日程与竞争责任；4）耻辱感与身体和心理健康不佳。
了解成功治疗阿片类药物使用障碍结果的障碍，并考虑其共同发生，可能有助于识别和促进干预措施，以减轻其影响。这项工作旨在指导未来的研究，以调整理解影响阿片类药物使用障碍治疗的心理社会和结构障碍的概念框架，并最终改善治疗结果的干预努力。
