Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut Street, Philadelphia, PA, 19107, USA; Center for Connected Care, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, 1015 Walnut Street, Philadelphia, PA, 19107, USA; College of Population Health, Thomas Jefferson University, 901 Walnut Street, Philadelphia, Pennsylvania, 19107, USA.
Center for Connected Care, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, 1015 Walnut Street, Philadelphia, PA, 19107, USA.
J Subst Use Addict Treat. 2024 Dec;167:209509. doi: 10.1016/j.josat.2024.209509. Epub 2024 Sep 6.
In 2022, 1413 people in Philadelphia died of an unintentional drug overdose. Addressing the complex challenges within the opioid use disorder (OUD) treatment system requires a comprehensive grasp of multiple system-level siloes from the perspective of patients who are accessing services and certified recovery specialists. Identifying facilitators and barriers to treatment entry and retention are critical.
We conducted 13 focus groups with 70 people with a history of opioid use in Philadelphia, Pennsylvania. The study recruited participants from non-profit organizations, OUD treatment programs, and street intercept. Certified Recovery Specialists (CRS), people with experience in residential, outpatient, methadone, and buprenorphine programs in Philadelphia, identity-specific groups with Black women, Black men, and Latino men, pregnant and parenting people, and people accessing harm reduction services participated in focus groups. Focus group guides varied by group, but the overarching focus remained on understanding participants' experiences in navigating the OUD treatment system. The research team summarized and edited CRS focus groups and coded all other focus groups for thematic analysis.
Most focus group participants (mean age = 45.1 years; 52.9 % men, 40 % Black) had a history with multiple treatment types and reported experiences with different modalities. Salient themes that emerged from analysis included frustrations with the assessment process; reflections on facilitators and barriers by treatment type (residential, methadone, and buprenorphine); and recommendations across treatment modalities. Assessment centers, rather than being easy points of treatment entry, were identified as a major barrier to OUD treatment initiation; issues discussed included length of assessment, limited operating hours, and inadequate withdrawal management.
The data from the present study were used to develop recommendations for policymakers and other stakeholders of OUD treatment programs to improve care across the spectrum of services. Expansion of residential programs that can support patients with complex comorbid conditions and wounds is needed to prevent delays for patients deemed ineligible for lower levels of care. Housing and income were identified as significant deterrents to initiating drug treatment and greater resources are needed. Greater investment in the OUD workforce is needed, especially expanding staff with lived experience. Findings can enhance OUD treatment programs elsewhere.
2022 年，费城共有 1413 人死于非故意药物过量。要解决阿片类药物使用障碍（OUD）治疗系统中的复杂挑战，需要从正在接受服务的患者和经过认证的康复专家的角度全面了解多个系统层面的情况。确定治疗的进入和保持的促进因素和障碍是至关重要的。
我们在宾夕法尼亚州费城进行了 13 次有 70 名有阿片类药物使用史的人的焦点小组讨论。该研究从非营利组织、OUD 治疗项目和街头拦截处招募参与者。经过认证的康复专家（CRS）、在费城有住宅、门诊、美沙酮和丁丙诺啡项目经验的人、黑人女性、黑人男性和拉丁裔男性特定身份群体、怀孕和育儿的人以及接受减少伤害服务的人参加了焦点小组。焦点小组指南因小组而异，但总体重点仍然是了解参与者在导航 OUD 治疗系统方面的经验。研究小组总结和编辑了 CRS 焦点小组，并对所有其他焦点小组进行了主题分析编码。
大多数焦点小组参与者（平均年龄 45.1 岁；52.9%为男性，40%为黑人）有多种治疗类型的病史，并报告了不同模式的经验。分析中出现的突出主题包括对评估过程的不满；对治疗类型（住宅、美沙酮和丁丙诺啡）的促进因素和障碍的反思；以及治疗模式之间的建议。评估中心不是治疗的简单切入点，而是被确定为开始 OUD 治疗的主要障碍；讨论的问题包括评估时间的长短、有限的工作时间和不充分的戒断管理。
本研究的数据被用于为 OUD 治疗计划的政策制定者和其他利益相关者制定建议，以改善整个服务范围内的护理。需要扩大能够支持患有复杂合并症和伤口的患者的住宅项目，以防止因被认为不符合较低水平护理而延误患者。住房和收入被认为是开始药物治疗的重大障碍，需要更多的资源。需要对 OUD 劳动力进行更多投资，特别是扩大具有亲身体验的员工。研究结果可以提高其他地方的 OUD 治疗计划。
