University of Colorado College of Nursing, Aurora.
J Addict Nurs. 2023;34(3):E119-E134. doi: 10.1097/JAN.0000000000000475.
Buprenorphine and methadone, when used as maintenance therapy in opioid use disorder (OUD), can significantly reduce the risk of death after an opioid overdose. Despite the many benefits, medication for OUD (MOUD) remains controversial and underutilized. The aim of this study was to (a) identify studies that explicate the lived experience of MOUD, (b) conduct a methodologically sound critical quality assessment, (c) conduct a metasynthesis of identified qualitative studies, and (d) analyze the results through the lenses of critical social justice, feminist standpoint, and social theories to inform a more culturally responsive, effective, and holistic approach to treatment to increase the utilization of and receptivity to MOUD in the treatment of OUDs.
Metasynthesis is the deliberate process of synthesizing data from multiple qualitative studies to create a new interpretation of previously published research. Our metasynthesis focused on forming a new interpretation of the lived experience of MOUD. Of the 292 studies identified, eight met inclusion criteria. The overall quality of the studies was variable. The study population included adults aged ≥ 18 years with OUD or dependency.
Metasynthesis produced three overarching themes: (a) The duplexity of MOUD creates ambivalence in how a person experiences MOUD; (b) the structure of treatment and systemic influences matter, and (c) MOUD as a stepping-stone with multiple meanings in recovery.
Understanding experiential dualities allows professionals to see from other perspectives and can inform interventions and treatment structures as well as serve as a backdrop for social change. The synthesized new meaning of MOUD was an ambivalent experience influenced by intersectionality.
丁丙诺啡和美沙酮作为阿片类药物使用障碍(OUD)的维持治疗,可以显著降低阿片类药物过量后的死亡风险。尽管有许多好处,阿片类药物使用障碍(MOUD)的药物治疗仍然存在争议且未得到充分利用。本研究的目的是:(a)确定阐明 MOUD 患者体验的研究;(b)进行方法学上合理的批判性质量评估;(c)对确定的定性研究进行综合分析;(d)通过批判性社会正义、女性主义立场和社会理论的视角分析结果,为治疗提供更具文化响应性、有效性和整体性的方法,以增加 MOUD 在治疗 OUD 中的应用和接受度。
综合分析是从多个定性研究中综合数据以对先前发表的研究进行新解释的有意过程。我们的综合分析侧重于形成对 MOUD 患者体验的新解释。在确定的 292 项研究中,有 8 项符合纳入标准。研究人群包括年龄≥18 岁的患有 OUD 或依赖的成年人。
综合分析产生了三个总体主题:(a)MOUD 的双重性导致人们对 MOUD 的体验产生矛盾心理;(b)治疗结构和系统影响很重要;(c)MOUD 是康复过程中的一个阶段性步骤,具有多种含义。
理解体验的双重性可以让专业人员从其他角度看待问题,并为干预措施和治疗结构提供信息,也可以作为社会变革的背景。综合分析得出的 MOUD 的新含义是一种受交叉性影响的矛盾体验。