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Kleinman MB, Hines AC, Anvari MS, Bradley VD, Shields A, Dean D, Abidogun TM, Jack HE, Magidson JF. "You rise up and then you start pulling people up with you": Patient experiences with a peer-delivered behavioral activation intervention to support methadone treatment. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 122:104234. [PMID: 37866292 PMCID: PMC10872983 DOI: 10.1016/j.drugpo.2023.104234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 10/06/2023] [Accepted: 10/07/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Although medications for opioid use disorder (MOUD) are efficacious treatments for opioid use disorder, retention remains low. Peer recovery specialists (PRSs), individuals with lived substance use and recovery experience, may be particularly well-suited to support patients receiving MOUD. While PRSs are rarely trained in evidence-based behavioral interventions other than motivational interviewing, preliminary evidence suggests that peers can deliver brief behavioral interventions, such as behavioral activation, with efficacy and fidelity. This qualitative study sought to explore patient perspectives on receiving an adapted PRS-delivered behavioral activation intervention (Peer Activate) to support patients receiving methadone treatment. METHODS The sample (N = 26) included patients recently starting or demonstrating challenges with adherence at a community-based methadone treatment program who received the Peer Activate intervention in a pilot trial. Participants were invited to participate in in-depth, semi-structured interviews at study completion or discontinuation, assessing perceived acceptability and feasibility of Peer Activate, and stigma-related barriers. Interview transcripts were coded using codebook/template thematic analysis. RESULTS Analysis revealed the importance of two areas to promote intervention acceptability: 1) connection with intervention content and skill building, and 2) valued PRS-specific qualities. Intervention flexibility was found to promote feasibility of the intervention in the context of chaotic and challenging life circumstances. Additionally, participants described stigma towards substance use and methadone treatment as potential barriers to engaging in methadone treatment. CONCLUSION Results support the acceptability and feasibility to patients of this PRS-delivered behavioral activation intervention in the context of outpatient MOUD treatment among a low-income, majority racially minoritized patient population. Future intervention adaptation and implementation should focus on incorporating content related to relationships and interpersonal skills; balancing behavioral intervention content with system navigation support; maintaining flexibility; and further investigation of the impact of individual PRS attributes, including shared lived experiences, on intervention acceptability and shifts in stigma.
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Affiliation(s)
- Mary B Kleinman
- Department of Psychology, University of Maryland, College Park, MD, USA.
| | - Abigail C Hines
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Morgan S Anvari
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Valerie D Bradley
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Alia Shields
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Dwayne Dean
- Department of Psychology, University of Maryland, College Park, MD, USA
| | | | - Helen E Jack
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Jessica F Magidson
- Department of Psychology, University of Maryland, College Park, MD, USA; Center for Substance Use, Addiction & Health Research (CESAR), University of Maryland, College Park, MD, USA
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Kleinman MB, Anvari MS, Seitz-Brown CJ, Bradley VD, Tralka H, Felton JW, Belcher AM, Greenblatt AD, Magidson JF. Psychosocial challenges affecting patient-defined medication for opioid use disorder treatment outcomes in a low-income, underserved population: Application of the social-ecological framework. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 149:209046. [PMID: 37061189 PMCID: PMC10229107 DOI: 10.1016/j.josat.2023.209046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 11/27/2022] [Accepted: 04/11/2023] [Indexed: 04/17/2023]
Abstract
INTRODUCTION Successful engagement with medication treatment for opioid use disorder is an important focus in reducing mortality associated with the opioid crisis. Mortality remains at unacceptably high levels, pointing to a need for improved understanding of factors that affect medication for opioid use disorder outcomes. This study aims to understand how barriers co-occur and interact to interfere with outcomes in methadone treatment for a low-income, underserved patient population with opioid use disorder. METHODS This study was conducted at a community-based drug treatment center that serves a predominately low-income, racially diverse population. Guided by the social-ecological framework, we analyzed semi-structured interviews and focus groups with patients and providers working in opioid use disorder care and recovery across Baltimore City (N = 32) to assess factors that influence methadone treatment outcomes, and how barriers co-occur and interact to worsen treatment outcomes. The study used patient-centered definitions to describe successful treatment outcomes. RESULTS Barriers described by both patients and providers fit into several broad levels: individual, interpersonal, institutional, community, and stigma. Participants described co-occurrence of many barriers. Further, the study identified potential interactive effects, such that interrelated barriers were seen as fueling one another and having a deleterious effect on treatment outcomes. Specifically, interrelationships between barriers were described for 1) unstable housing with social influences and mental health factors; 2) transportation with poor physical health and other competing responsibilities; 3) treatment program policies and schedule with competing responsibilities; and 4) stigma with poor physical and mental health. CONCLUSIONS Understanding barriers to successful medication for opioid use disorder outcomes and considering their co-occurrence may help to identify and promote interventions to mitigate their impact. This work is intended to guide future research to adapt conceptual frameworks for understanding psychosocial and structural barriers affecting opioid use disorder treatment and ultimately intervention efforts to improve treatment outcomes.
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Affiliation(s)
- Mary B Kleinman
- Department of Psychology, University of Maryland at College Park, College Park, MD, USA.
| | - Morgan S Anvari
- Department of Psychology, University of Maryland at College Park, College Park, MD, USA
| | - C J Seitz-Brown
- Department of Psychology, University of Maryland at College Park, College Park, MD, USA
| | - Valerie D Bradley
- Department of Psychology, University of Maryland at College Park, College Park, MD, USA
| | - Hannah Tralka
- Department of Psychology, University of Maryland at College Park, College Park, MD, USA
| | | | - Annabelle M Belcher
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Aaron D Greenblatt
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jessica F Magidson
- Department of Psychology, University of Maryland at College Park, College Park, MD, USA; Center for Substance Use, Addiction & Health Research (CESAR), University of Maryland, College Park, MD, USA
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Haines M, O'Byrne P. Safer opioid supply: qualitative program evaluation. Harm Reduct J 2023; 20:53. [PMID: 37081500 PMCID: PMC10117245 DOI: 10.1186/s12954-023-00776-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 03/30/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND As the overdose crisis in Canada continues to escalate in severity, novel interventions and programs are required. Safer Supply programs offer pharmaceutical-grade medication to people who use drugs to replace and decrease harms related to the toxic illicit drug supply. Given the paucity of research surrounding these programs, we sought to better understand the experience of being part of a Safer Supply program from the perspective of current participants. METHODS We completed semi-structured interviews and surveys with Safer Supply participants in Ottawa, Canada. Interviews were audio-recorded, transcribed, and analyzed thematically. Descriptive statistics were used to report survey data. RESULTS Participants most commonly discussed Safer Supply benefits. This included programs offering a sense of community, connection, hope for the future, and increased autonomy. Participants also described program concerns, such as restrictive protocols, inadequate drugs, and diversion. CONCLUSIONS Our research demonstrated that participants found Safer Supply to be effective and impactful for their substance use goals. While participants did discuss concerns about the program, overall, we found that this is an important harm reduction-based program for people who use drugs in the midst of the overdose crisis.
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Affiliation(s)
- Marlene Haines
- School of Nursing, University of Ottawa, Guindon Hall RGN 3051, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.
| | - Patrick O'Byrne
- School of Nursing, University of Ottawa, Guindon Hall RGN 3051, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
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Seabra PRC, Brantes ALG, Sequeira RMR, Sequeira ACOA, Simões ASA, Nunes IDCBR, Amaral PE, Sequeira CAC. Acceptability and applicability of an intervention programme with substance addicts. CIENCIA & SAUDE COLETIVA 2023; 28:1175-1186. [PMID: 37042898 DOI: 10.1590/1413-81232023284.11732022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 09/28/2022] [Indexed: 04/13/2023] Open
Abstract
The complexity of the problems related to the harmful use of substances requires regular questioning of practices. This article aims to explore the acceptability and applicability of an intervention programme for patients with problematic substance use. Qualitative study. Data collection, through a focus group with 6 nurses and 6 semi-structured interviews with patients under treatment. We have used lexicographic textual analysis. From the focus group, 151 text segments were analysed, retaining 85.8% of the total for the creation of five classes. An analysis of similarity led to the formation of two central nuclei, represented by the words "Nursing" and "Intervention". From interviews, 252 text segments were analysed, retaining 71.83% for the creation of 5 classes. An analysis of similarity led to the formation of three central nuclei, represented by the words "want", "programme" and "see". Nurses recognise the need for a more structured and flexible approach focused on people's needs. Users also affirm the need for flexible interventions, without a pre-established time frame, that promote labour integration, therapeutic support for abstinence and management of comorbidities.
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Affiliation(s)
- Paulo Rosário Carvalho Seabra
- Centro de Investigação, Inovação e Desenvolvimento em Enfermagem de Lisboa (CIDNUR), Escola Superior de Enfermagem de Lisboa (ESEL). Av. Prof. Egas Moniz 1600. Lisboa Portugal.
- Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS-NursID), Escola Superior de Enfermagem do Porto, Faculdade de Medicina da Universidade do Porto (FMUP). Porto Portugal
| | | | - Rui Manuel Russo Sequeira
- Equipa Técnica Especializada de Tratamento do Barreiro, Divisão de Intervenção nos Comportamentos Aditivos e Dependências (DICAD). Barreiro Portugal
| | - Ana Cristina Oliveira Arroja Sequeira
- Equipa Técnica Especializada de Tratamento do Barreiro, Divisão de Intervenção nos Comportamentos Aditivos e Dependências (DICAD). Barreiro Portugal
| | - Ana Susete Abreu Simões
- Equipa Técnica Especializada de Tratamento do Barreiro, Divisão de Intervenção nos Comportamentos Aditivos e Dependências (DICAD). Barreiro Portugal
| | - Inês da Cunha Baetas Robalo Nunes
- Centro de Investigação, Inovação e Desenvolvimento em Enfermagem de Lisboa (CIDNUR), Escola Superior de Enfermagem de Lisboa (ESEL). Av. Prof. Egas Moniz 1600. Lisboa Portugal.
| | - Paula Edna Amaral
- Equipa Técnica Especializada de Tratamento do Barreiro, Divisão de Intervenção nos Comportamentos Aditivos e Dependências (DICAD). Barreiro Portugal
| | - Carlos Alberto Cruz Sequeira
- Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS-NursID), Escola Superior de Enfermagem do Porto, Faculdade de Medicina da Universidade do Porto (FMUP). Porto Portugal
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Examining Relational Dimensions of Service Encounters for Disadvantaged People Who Use Drugs. J Addict Nurs 2022; 33:159-167. [DOI: 10.1097/jan.0000000000000479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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