School of Global and Integrative Studies, University of Nebraska-Lincoln, 839 Oldfather Hall, Lincoln, NE, 68588, USA.
Center for Ethics Education, Fordham University, Rose Hill Campus, Dealy Hall, Room 117, New York City, NY, 10023, USA.
Harm Reduct J. 2024 Apr 25;21(1):85. doi: 10.1186/s12954-024-01006-w.
During the COVID-19 pandemic, clinics offering medication for opioid use disorder (MOUD) needed to rapidly introduce unsupervised take-home dosing, while relapsing patients and patients unable to enter treatment faced increased risks of fentanyl-related overdose deaths and other drug-related harms. Based on a qualitative study of people who inject drugs (PWID) receiving MOUD treatment and MOUD staff in Puerto Rico, this paper documents the lived experiences of patients and providers during this period and the risk perceptions and management strategies to address substance misuse and drug diversion attributable to unsupervised take-home-dose delivery.
In-depth qualitative interviews were conducted with patients (N = 25) and staff (N = 25) in two clinics providing MOUD in San Juan, Puerto Rico, during 2022. Patients and staff were receiving or providing treatment during the pandemic, and patients reported injection drug use during the past thirty days.
Patients were overwhelmingly male (84%), unmarried (72%), and unemployed (52%), with almost half (44%) injecting one to three times a day. Mean time in treatment was 7 years. Staff had a mean age of 46 years with more than half of the sample (63%) female. The majority of patients believed that unsupervised take-home dosing had no significant effect on their treatment adherence or engagement. In contrast, providers expressed concerns over the potential for drug diversion and possible increased risks of patient attrition, overdose episodes, and poor treatment outcomes.
This study underscores the importance of insider perspectives on harm-reduction changes in policy implemented during a health crisis. Of note is the finding that staff disagreed among themselves regarding the potential harms of diversion and changes in drug testing protocols. These different perspectives are important to address so that future pandemic policies are successfully designed and implemented. Our study also illuminates disagreement in risk assessments between patients and providers. This suggests that preparation for emergency treatment plans requires enhanced communication with patients to match treatments to the context of lived experience.
在 COVID-19 大流行期间，提供阿片类药物使用障碍（MOUD）药物的诊所需要迅速引入无人监督的带药回家剂量，而复发患者和无法进入治疗的患者面临着芬太尼相关过量死亡和其他与药物相关的伤害风险增加。基于对波多黎各接受 MOUD 治疗的注射吸毒者（PWID）和 MOUD 工作人员的定性研究，本文记录了在此期间患者和提供者的生活经历，以及针对无人监督的带药回家剂量给药导致的药物滥用和药物转移风险的感知和管理策略。
在 2022 年，对波多黎各圣胡安的两家提供 MOUD 的诊所的患者（N=25）和工作人员（N=25）进行了深入的定性访谈。患者和工作人员都在大流行期间接受或提供治疗，并且患者报告在过去三十天内有注射吸毒行为。
患者绝大多数为男性（84%）、未婚（72%）和失业（52%），近一半（44%）每天注射一到三次。平均治疗时间为 7 年。工作人员的平均年龄为 46 岁，超过一半的样本（63%）为女性。大多数患者认为无人监督的带药回家剂量对他们的治疗依从性或参与度没有显著影响。相比之下，工作人员对药物转移的潜在可能性以及患者流失、过量发作和治疗结果不佳的潜在风险表示担忧。
这项研究强调了在卫生危机期间实施的政策中，了解内部人士对减少伤害变化的看法的重要性。值得注意的是，工作人员对药物转移的潜在危害以及药物检测协议的变化存在分歧。这些不同的观点对于未来的大流行政策的成功设计和实施非常重要。我们的研究还凸显了患者和提供者之间在风险评估方面的分歧。这表明，为紧急治疗计划做准备需要加强与患者的沟通，使治疗与生活经历的背景相匹配。
