背景:自从COVID-19大流行爆发以来,北美的用药过量率持续上升,在过去的一年里,有超过10万人死于药物中毒。在日益有毒的药物供应中,这场大流行扰乱了基本药物使用治疗和减少伤害的服务,这些服务降低了吸毒人群的过量风险。在不列颠哥伦比亚省,一种这样的治疗是可注射阿片类激动剂治疗(iOAT),对于阿片类药物使用障碍患者,可注射氢吗啡酮或二乙酰吗啡的监督分配。虽然有证据表明iOAT是安全有效的,它是密集和高度集中的,其特点是每日门诊就诊和提供者-患者互动-治疗部分因大流行而变得困难。
方法:在2020年4月至2021年2月之间,我们对18名iOAT客户和两名诊所护士进行了51次访谈,以了解大流行如何影响iOAT的获取和治疗经验。为了分析采访数据,我们采用了多步骤,灵活的编码策略,一种迭代和诱惑力的分析方法,使用NVivo软件。
结果:定性分析揭示了大流行影响客户生活和提供iOAT护理的方式。首先,客户的叙述说明了大流行是如何加剧现有的不平等现象的。例如,社会经济边缘化的客户对他们的金融稳定和对社区的经济影响表示担忧。第二,有健康合并症的客户认识到大流行是如何放大健康风险的,通过潜在的COVID-19暴露或通过限制社会关系和心理健康支持。第三,客户描述了大流行如何改变了他们与iOAT诊所和药物的接触。例如,客户指出,物理距离准则和占用限制减少了与员工和其他iOAT客户建立社会联系的机会。然而,大流行政策还创造了机会,以增加患者信任和自主权的方式调整治疗,例如,通过更灵活的药物治疗方案和带回家的口服剂量。
结论:参与者的叙述强调了大流行影响对吸毒者的不平等分布,但也强调了更灵活的机会,以患者为中心的治疗方法。跨治疗设置,大流行时代的变化将继续和扩大,这些变化将增加客户的自主权并确保公平获得护理的机会,超过大流行的持续时间。
Since the onset of the COVID-19 pandemic, overdose rates in North America have continued to rise, with more than 100,000 drug poisoning deaths in the past year. Amidst an increasingly toxic drug supply, the pandemic disrupted essential substance use treatment and harm reduction services that reduce overdose risk for people who use drugs. In British Columbia, one such treatment is injectable opioid agonist treatment (iOAT), the supervised dispensation of injectable hydromorphone or diacetylmorphine for people with opioid use disorder. While evidence has shown iOAT to be safe and effective, it is intensive and highly regimented, characterized by daily clinic visits and provider-client interaction-treatment components made difficult by the pandemic.
Between April 2020 and February 2021, we conducted 51 interviews with 18 iOAT clients and two clinic nurses to understand how the pandemic shaped iOAT access and treatment experiences. To analyze interview data, we employed a multi-step, flexible coding strategy, an iterative and abductive approach to analysis, using NVivo software.
Qualitative analysis revealed the ways in which the pandemic shaped clients\' lives and the provision of iOAT care. First, client narratives illuminated how the pandemic reinforced existing inequities. For example, socioeconomically marginalized clients expressed concerns around their financial stability and economic impacts on their communities. Second, clients with health comorbidities recognized how the pandemic amplified health risks, through potential COVID-19 exposure or by limiting social connection and mental health supports. Third, clients described how the pandemic changed their engagement with the iOAT clinic and medication. For instance, clients noted that physical distancing guidelines and occupancy limits reduced opportunities for social connection with staff and other iOAT clients. However, pandemic policies also created opportunities to adapt treatment in ways that increased patient trust and autonomy, for example through more flexible medication regimens and take-home oral doses.
Participant narratives underscored the unequal distribution of pandemic impacts for people who use drugs but also highlighted opportunities for more flexible, patient-centered treatment approaches. Across treatment settings, pandemic-era changes that increase client autonomy and ensure equitable access to care are to be continued and expanded, beyond the duration of the pandemic.