Navigating Opioid Agonist Therapy among Young People who use Illicit Opioids in Vancouver, Canada.
Navigating Opioid Agonist Therapy among Young People who use Illicit Opioids in Vancouver, Canada.
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DOI：
10.1016/j.drugpo.2022.103773
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发表时间：
2022-09
影响因子：
4.4
通讯作者：
Fast, Danya
中科院分区：
文献类型：
--
作者：
Pilarinos, Andreas;Kwa, Yandi;Joe, Ronald;Thulien, Madison;Buxton, Jane A.;DeBeck, Kora;Fast, Danya
阿片类激动剂治疗(OAT)已被证明可以减少阿片类药物的使用和相关的危害。然而，许多年轻人没有接触到审裁处。这项研究试图探索年轻人是如何随着时间的推移而使用燕麦片的，包括参与、脱离和回避的时期。在2018年1月至2020年8月期间，对加拿大温哥华56名报告非法、密集使用海洛因和/或芬太尼的年轻人进行了半结构化、深入的定性访谈。在逐字转写纵向访谈之后，使用迭代主题分析来推断关键主题。考虑燕麦片的年轻人表达了对其成瘾的担忧。许多人经历了来自提供者和家庭成员的压力，要求他们开始丁丙诺啡-纳洛酮治疗，尽管他们希望探索其他治疗方案，如美沙酮。一旦年轻人开始服用燕麦片，坚持下去就变得困难和复杂，因为每天都有剂量要求和关于反复错过剂量的严格规定，特别是对于那些接受美沙酮治疗的人。大多数年轻人设想在不太遥远的将来逐渐减少燕麦片的数量。研究结果强调了与年轻人合作制定治疗计划和时间表的重要性，并建议可通过以下方式改善年轻人对燕麦片的参与和保留：扩大对各种燕麦片的获取；更新临床指南，以改进获得更安全的处方替代品的机会，以取代日益有毒、不受监管的药物供应；解决因错过剂量和带回家剂量而产生的治疗缺口；以及提供一条明确的减少燕麦片的途径。
Opioid agonist therapy (OAT) has been shown to reduce opioid use and related harms. However, many young people are not accessing OAT. This study sought to explore how young people navigated OAT over time, including periods of engagement, disengagement, and avoidance. Semi-structured, in-depth qualitative interviews were conducted between January 2018 and August 2020 with 56 young people in Vancouver, Canada who reported illicit, intensive heroin and/or fentanyl use. Following the verbatim transcription of longitudinal interviews, an iterative thematic analysis was used to extrapolate key themes. Young people contemplating OAT expressed fears about its addictiveness. Many experienced pressure from providers and family members to initiate buprenorphine-naloxone, despite a desire to explore other treatment options such as methadone. Once young people initiated OAT, staying on it was difficult and complicated by daily witnessed dosing requirements and strict rules around repeated missed doses, especially for those receiving methadone. Most young people envisioned tapering off OAT in the not-too-distant future. Findings underscore the importance of working collaboratively with young people to develop treatment plans and timelines, and suggest that OAT engagement and retention among young people could be improved by expanding access to the full range of OAT; updating clinical guidelines to improve access to safer prescription alternatives to the increasingly poisonous, unregulated drug supply; addressing treatment gaps arising from missed doses and take-home dosing; and providing a clear pathway to OAT tapering.
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影响因子：
4.2
作者：
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