Prescription Opioid Resiliency and Vulnerability: A Mixed-Methods Comparative Case Study.
Prescription Opioid Resiliency and Vulnerability: A Mixed-Methods Comparative Case Study.
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DOI：
10.1007/s12103-022-09701-9
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发表时间：
2022
影响因子：
5.6
通讯作者：
Monnat, Shannon M
中科院分区：
文献类型：
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作者：
Hochstetler, Andy;Peters, David J;Monnat, Shannon M
尽管处方阿片类药物过量有所下降，但农村地区的处方阿片类药物过量比率仍然高于城市地区。我们的目标是了解高过量地区对处方阿片类药物过量危机的弹性(比预期的好)，而其他地方是脆弱的(比预期的更差)。首先，我们使用多变量回归计算预测了N = 2,013个非大都市县2016-18年的处方阿片类药物过量死亡率。其次，我们使用回归的观测值、预测值和残差值构建了弹性-脆弱性类型学。第三，我们选择了一个高过量、有弹性和脆弱的社区进行案例研究，使用访谈、焦点小组和观察。高过量、恢复力强和脆弱的地方有残疾分配-过量用药途径、采矿遗留问题和多物质药物滥用。有复原力的地方有更多的人口，有广泛的保健和社会服务，有救赎和接受成瘾的规范，以及在全社区范围内调动公共和非营利资源。易受伤害的地方更小，更偏远，缺乏服务，并被污名化成瘾。
Despite declines in prescription opioid overdoses, rural areas continue to have higher prescription opioid overdose rates than urban areas. We aim to understand high overdose places were resilient to the prescription opioid overdose crisis (better than predicted), while others were vulnerable (worse than predicted). First, we predicted prescription opioid overdose mortality in 2016–18 for N = 2,013 non-metropolitan counties using multivariable regression accounting. Second, we constructed a resiliency-vulnerability typology using observed, predicted, and residual values from the regression. Third, we selected a high-overdose resilient and vulnerable community for case study analysis using interviews, focus groups, and observations. High-overdose resilient and vulnerable places had disability-dispensing-overdose pathways, legacies of mining, and polysubstance drug abuse. Resilient places were larger population micropolitans with extensive health and social services, norms of redemption and acceptance of addiction, and community-wide mobilization of public and non-profit resources. Vulnerable places were smaller, more remote, lacked services, and stigmatized addiction.