Rivera Dean, Dasgupta Anindita, Cogan Allyson G, Bartkus Mary, Wu Elwin, Campbell Aimee N C, El-Bassel Nabila
Columbia School of Social Work, Columbia University, 1225 Amsterdam Ave, New York, NY 10027, United States.
Boston Medical Center, 801 Massachusetts Ave 2nd Floor, Boston, MA 02119, United States.
Int J Drug Policy. 2025 Jul 16;143:104922. doi: 10.1016/j.drugpo.2025.104922.
In response to rising overdose deaths, the State of New York established multisystem coalitions in 16 counties to tackle the opioid crisis. These coalitions brought together stakeholders from various systems, including healthcare, behavioral health, criminal justice, and community-based services to address the epidemic in a coordinated community driven approach. The literature shows the implementation of effective, evidence-based community interventions is often hindered by differing values (attitudes, beliefs, and norms) between stakeholders of these coalitions and the communities where evidence-based approaches are implemented. This paper investigates how these divergent or shared values affect the implementation of naloxone and medications for opioid use disorder interventions.
We conducted a thematic analysis of semistructured interviews (n = 43) with coalition members representing multiple systems across eight New York counties. The analysis was guided by Interorganizational Relations and Resource Dependence Theories to examine how differing or shared values influenced the implementation of community-based opioid use disorder interventions.
Five themes emerged on how divergent or shared intersystem and community values affected OUD interventions: a) shared values among coalition systems, b) divergent values between coalition systems, c) community education and destigmatization efforts, d) moral culpability of people who use opioids (PWUO), and e) value judgments of moral worthiness.
Aligning values across systems and communities is crucial for effectively implementing community-based interventions aimed at combating the opioid epidemic. Shifting systemic and community narratives from value judgments of moral worthiness and the moral culpability of PWUO to recognizing OUD as a chronic health disorder is key to achieving this alignment. Central to this effort are community education and destigmatization campaigns, which play a pivotal role in promoting a unified multisystem-community approach.
为应对过量用药死亡人数的上升，纽约州在16个县建立了多系统联盟，以应对阿片类药物危机。这些联盟将来自医疗保健、行为健康、刑事司法和社区服务等不同系统的利益相关者聚集在一起，以社区驱动的协调方式应对这一流行病。文献表明，有效的循证社区干预措施的实施往往受到这些联盟的利益相关者与实施循证方法的社区之间不同价值观（态度、信仰和规范）的阻碍。本文调查了这些不同或共享的价值观如何影响纳洛酮和阿片类药物使用障碍干预药物的实施。
我们对来自纽约州八个县、代表多个系统的联盟成员进行了43次半结构化访谈，并进行了主题分析。该分析以组织间关系和资源依赖理论为指导，以研究不同或共享的价值观如何影响基于社区的阿片类药物使用障碍干预措施的实施。
出现了五个关于不同或共享的系统间和社区价值观如何影响阿片类药物使用障碍干预措施的主题：a）联盟系统间的共享价值观；b）联盟系统间的不同价值观；c）社区教育和消除污名化努力；d）阿片类药物使用者的道德罪责；e）道德价值的价值判断。
使各系统和社区的价值观保持一致对于有效实施旨在抗击阿片类药物流行的社区干预措施至关重要。将系统和社区的叙述从对道德价值的价值判断和阿片类药物使用者的道德罪责转变为将阿片类药物使用障碍视为一种慢性健康疾病，是实现这种一致的关键。这项工作的核心是社区教育和消除污名化运动，它们在促进统一的多系统-社区方法方面发挥着关键作用。
