Improving Treatment Strategies for Prescription Opioid Use Disorder- Resubmission

项目摘要 迫切需要更有效的治疗战略，以解决存在的公共卫生危机 由于处方阿片类药物（PO）使用障碍的急剧增加和证据利用不足- 药物辅助治疗（MAT）。阿片类药物使用在南方农村的增加， 滥用率最高，令人震惊。阐明促进寻求和维持MAT的因素， 为了改善治疗的实施和结果，这一人群是必不可少的。目标 本研究的主要目的是：（1）从个人的角度，识别寻求MAT的关键决策因素 PO使用障碍进入门诊PO治疗在农村南部国家;（2）确定关键决策 入组门诊MAT以继续/中止治疗的PO使用障碍患者中的因素 阿片类激动剂或拮抗剂治疗后完成解毒;和（3）识别和表征 有助于成功戒毒和治疗结果的个人和背景因素 在16周随访时寻求MAT治疗PO使用障碍的人群中。为了实现这一点， 我们将进行为期16周的重点民族志研究，包括深入的定性访谈， 30名患有PO使用障碍的寻求治疗的个体入组正在进行的临床试验 （R 01 DA 039088），旨在改善PO使用障碍的治疗、保留和结局。鉴于 目前缺乏关于农村PO使用者寻求PO使用障碍治疗的信息， 定性的方法将使我们能够对周围的复杂性进行深入，详细的分析， 这个重要的决定。这项研究的结果将增加我们对相关个人， 社会和治疗相关的问题，影响农村PO用户之间的治疗决定。这些数据 将是无价的，因为我们从理解寻求治疗转向发展循证医学， 干预措施是可以接受的，促进保留，农村人与PO使用障碍，因为他们将 以他们的观点为基础，并根据他们的需要和偏好进行调整。

PROJECT SUMMARY There is critical need for more effective treatment strategies to address the public health crisis that exists due to the dramatic rise in prescription opioid (PO) use disorder and the underutilization of evidence- based medication-assisted treatments (MAT). The rise of opioid use in the rural South, where opioid abuse rates are highest, is alarming. Elucidation of factors that promote seeking and sustaining MAT in this population is imperative in order to improvement treatment implementation and outcomes. The aims of this project are to: (1) identify key decision factors for seeking MAT from the perspective of persons with PO use disorder entering outpatient PO treatment in a rural Southern state; (2) identify key decision factors among persons with PO use disorder enrolled in outpatient MAT for continuing/discontinuing with opioid agonist or antagonist treatment after completing detoxification; and (3) to identify and characterize individual- and contextual-level factors contributing to successful detoxification and treatment outcomes among a cohort of persons seeking MAT for PO use disorder at 16-week follow-up. To accomplish this, we will conduct a 16 week focused ethnographic study that includes in-depth qualitative interviews with 30 treatment-seeking individuals with PO use disorder who are enrolled in an ongoing clinical trial (R01DA039088) that seeks to improve treatment, retention and outcomes for PO use disorder. Given the current dearth of information regarding treatment-seeking for PO use disorder among rural PO users, qualitative methods will allow us to develop an in-depth, detailed analysis of the complexities surrounding this important decision. Findings from this study will increase our understanding of the related personal, social, and treatment-related issues that influence treatment decisions among rural PO users. These data will be invaluable as we move from understanding treatment-seeking to developing evidence-based interventions that are acceptable, promoting retention, to rural persons with PO use disorder, as they will be based on their perspectives and tailored to their needs and preferences.