Alexander Savannah P, Shelton Elizabeth, Lee Matthew, Tharp G, McNeil Michael, Bernitz Melanie, Graves Kevin, Metsch Lisa R, Shelton Rachel C
Res Sq. 2025 Aug 21:rs.3.rs-7313339. doi: 10.21203/rs.3.rs-7313339/v1.
The United States opioid epidemic's reach is expanding. Rapidly scaling opioid education and naloxone distribution (OEND) programs is essential within a multipronged public health response. Universities offer infrastructure with potential to support routine, widespread OEND implementation among adolescents and young adults nationally, a priority population who could disseminate to broader networks and geographic communities. This important setting is underutilized, and critical gaps remain in understanding university-based OEND program adoption/implementation. We conducted semi-structured, in-depth interviews (n=21) among a purposively selected national sample of college health administrators to understand their perceptions of barriers/facilitators of implementing OEND programs at their universities and among universities nationally. The Consolidated Framework for Implementation Research guided data collection and inductive-deductive thematic analysis. Regarding ( ), and (emergent code in the domain), participants described the need for compelling justification to adopt, implement, and prioritize university-based OEND programs. The key justification for administration was student opioid overdose and mortality events. Absent these events and regarding ( ), participants described the need for student opioid misuse data to justify investment. Regarding ( ) and ( ), participants indicated that a university's level of community obligation and integration determined which opioid overdoses and misuse data administration deemed relevant to justify adoption. Regarding ( ), ( ); , , and ( ), participants described external/internal collaborators' key roles in OEND program adoption/implementation. Regarding ( ), participants described the need to manage political risk, implicating stigma against harm reduction programming. Regarding and ( ), participants illustrated a trajectory in which their institutions prioritized recovery programming for years before prioritizing harm reduction programming (e.g., OEND programs). Our findings underscore the complexity of university-based OEND program implementation while providing actionable insights to support its national scale-up. Building on identified distinctions between non-implementing and implementing universities, future research should establish OEND programming implementation phase among universities nationally, advance understanding of implementation determinants and strategies distinguishing each phase, and establish core components and best practices.
美国阿片类药物流行的影响范围正在扩大。在多方面的公共卫生应对措施中，迅速扩大阿片类药物教育和纳洛酮分发（OEND）项目至关重要。大学提供了基础设施，有潜力在全国范围内支持在青少年和青年中常规、广泛地实施OEND项目，这一重点人群可以向更广泛的网络和地理社区传播相关信息。这一重要场所未得到充分利用，在理解基于大学的OEND项目的采用/实施方面仍存在关键差距。我们对全国范围内有目的地挑选的大学健康管理人员样本进行了半结构化的深入访谈（n = 21），以了解他们对在其大学及全国范围内的大学实施OEND项目的障碍/促进因素的看法。实施研究综合框架指导了数据收集和归纳 - 演绎主题分析。关于（ ）、（ 领域中的新出现代码），参与者描述了采用、实施基于大学的OEND项目并将其列为优先事项需要有令人信服的理由。行政部门的关键理由是学生阿片类药物过量和死亡事件。如果没有这些事件，关于（ ），参与者描述了需要学生阿片类药物滥用数据来证明投资的合理性。关于（ ）和（ ），参与者表示，大学的社区义务和整合程度决定了行政部门认为哪些阿片类药物过量和滥用数据与证明采用的合理性相关。关于（ ）、（ ）；（ ）、（ ）和（ ），参与者描述了外部/内部合作者在OEND项目采用/实施中的关键作用。关于（ ），参与者描述了管理政治风险的必要性，这涉及到对减少伤害项目的污名化。关于（ ）和（ ），参与者阐述了他们的机构在将减少伤害项目（如OEND项目）列为优先事项之前，先将康复项目列为优先事项多年的一个过程。我们的研究结果强调了基于大学的OEND项目实施的复杂性，同时提供了可操作的见解以支持其在全国范围内的扩大。基于已确定的未实施和实施OEND项目的大学之间的差异，未来的研究应确定全国范围内大学的OEND项目实施阶段，加深对区分每个阶段的实施决定因素和策略的理解，并确定核心组成部分和最佳实践。
