Masson Carmen L, Knight Kelly R, Levine Emily A, Spillane Joseph A, Liang Ya Chi Angelina, Suen Leslie W, Chen Maggie M, Zevin Barry, Schwartz Robert P, Coffin Phillip O, Sorensen James L
Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA.
Department of Humanities and Social Sciences and Center for Vulnerable Populations, University of California, San Francisco, San Francisco, CA, USA.
J Urban Health. 2025 Apr;102(2):465-475. doi: 10.1007/s11524-025-00967-y. Epub 2025 Mar 27.
People experiencing homelessness (PEH) face a high risk of opioid-related deaths, yet there is limited qualitative data on the barriers encountered when accessing buprenorphine treatment for opioid use disorder (OUD). To address this gap, we interviewed 28 clinicians, outreach workers, and administrators from organizations serving PEH with OUD. Our goal was to understand the barriers and facilitators at the patient, clinic, and institutional levels and gather recommendations for improvement. Interviews, conducted via Zoom and analyzed through thematic analysis, revealed several barriers. At the patient level, themes related to barriers included knowledge and experience (e.g., limited knowledge about buprenorphine options; rejection of buprenorphine due to prior experience with precipitated withdrawal); concerns about the medication and its administration (e.g., distrust of injectable medications; concerns about treatment control, and a prolonged informed consent process for extended-release injectable buprenorphine); and challenges due to homelessness (e.g., identification requirement to access medication at pharmacies, difficulties managing buprenorphine while unsheltered). At the clinic level, themes centered around staffing (e.g., lack of training and experience in treating PEH and staffing shortages) and health care-related stigma (e.g., discriminatory attitudes toward PEH with OUD). Institutional-level themes included state-regulatory factors (e.g., practice regulations limiting clinical pharmacists' ability to prescribe buprenorphine) and access factors (e.g., stigmatization of buprenorphine prescribing, limited low-barrier buprenorphine access, and care system complexity). Recommendations included educational programs for patients and clinicians to increase understanding and reduce stigma, integrating buprenorphine treatment into non-traditional settings, and providing housing with treatment.
无家可归者面临与阿片类药物相关的死亡高风险，但关于在获得丁丙诺啡治疗阿片类药物使用障碍（OUD）时遇到的障碍的定性数据有限。为了填补这一空白，我们采访了28名来自为患有OUD的无家可归者提供服务的组织的临床医生、外展工作者和管理人员。我们的目标是了解患者、诊所和机构层面的障碍和促进因素，并收集改进建议。通过Zoom进行访谈并通过主题分析进行分析，发现了几个障碍。在患者层面，与障碍相关的主题包括知识和经验（例如，对丁丙诺啡选择的了解有限；由于先前有过戒断反应的经历而拒绝使用丁丙诺啡）；对药物及其给药的担忧（例如，对注射用药物的不信任；对治疗控制的担忧，以及长效注射用丁丙诺啡的延长知情同意过程）；以及无家可归带来的挑战（例如，在药店获取药物的身份识别要求，在无庇护情况下管理丁丙诺啡的困难）。在诊所层面，主题集中在人员配备（例如，在治疗无家可归者方面缺乏培训和经验以及人员短缺）和医疗保健相关的耻辱感（例如，对患有OUD的无家可归者的歧视态度）。机构层面的主题包括州监管因素（例如，实践法规限制临床药剂师开具丁丙诺啡的能力）和获取因素（例如，丁丙诺啡处方的污名化、低门槛丁丙诺啡获取有限以及护理系统复杂）。建议包括为患者和临床医生开展教育项目，以增加理解并减少耻辱感，将丁丙诺啡治疗纳入非传统环境，以及提供住房与治疗相结合的服务。
