Challenges for the implementation of injectable opioid agonist treatment: a scoping review.

IF 4 2区 社会学 Q1 SUBSTANCE ABUSE Harm Reduction Journal Pub Date : 2024-12-04 DOI:10.1186/s12954-024-01102-x
Tanja Schwarz, Deniz Akartuna, Martin Busch, R Michael Krausz, Alfred Uhl
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Abstract

Background and aims: Injectable opioid agonist treatment (iOAT) is a valuable, patient-centred, evidence based intervention. However, limited information exists on contextual factors that may support or hinder iOAT implementation and sustainability. This study aims to examine existing research on iOAT using diacetylmorphine and hydromorphone, focusing on identifying the key barriers and facilitators to its successful implementation.

Methods: A systematic search was conducted in the MEDLINE and PsycInfo databases (via Ovid) from inception to February 2024, supplemented by a comprehensive grey literature search. No restrictions were applied regarding publication type, year, or geographic location. Articles were independently screened by two reviewers. Eligible articles described the feasibility, implementation, and/or evaluation of iOAT in one or more countries, presenting perspectives on receiving, administering, or governing iOAT.

Results: Forty-four publications were selected for inclusion. Barriers identified through thematic analysis included public acceptance concerns such as medication diversion, increased crime, and the Honey-Pot effect. Legal and ethical challenges identified involved enacting changes in law to make certain substances available as a medically controlled options for treatment, and addressing patient consent issues. Negative media coverage and public controversies were found to undermine acceptance, and high start-up costs especially for security, facility access, and economic feasibility were seen as additional obstacles. Regulatory barriers and stringent protocols were the most frequently cited limiting factors by patients and providers. Facilitators included the integration of trial prescriptions into comprehensive drug policy strategies and publishing data for evidence-based debates, together with ethics committees ensuring compliance with ethical standards. Developing information strategies and addressing opponents' claims improved public perception. Cost-effectiveness evidence was found to support long-term implementation, while flexible treatment protocols, inclusive spaces, and affirming therapeutic relationships were seen as important facilitators to enhance patient engagement and treatment effectiveness.

Conclusions: Successful implementation of iOAT requires balancing political and social acceptability with scientific integrity, alongside strategic communication and public outreach. Further research is needed to enhance the transferability of findings across diverse socio-political contexts and address key influencing factors associated with iOAT programs.

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实施注射阿片类激动剂治疗的挑战:范围审查。
背景和目的:注射阿片类激动剂治疗(iOAT)是一种有价值的、以患者为中心的、基于证据的干预措施。然而,关于可能支持或阻碍iOAT实施和可持续性的背景因素的信息有限。本研究旨在回顾现有的使用二乙酰吗啡和氢吗啡酮的iOAT研究,重点确定其成功实施的关键障碍和促进因素。方法:系统检索MEDLINE和PsycInfo数据库(通过Ovid)自成立至2024年2月,并辅以综合灰色文献检索。对出版类型、出版年份或地理位置没有任何限制。文章由两位审稿人独立筛选。符合条件的文章描述了iOAT在一个或多个国家的可行性、实施和/或评估,提出了接受、管理或管理iOAT的观点。结果:44篇文献入选。通过专题分析确定的障碍包括公众接受问题,如药物转移、犯罪增加和蜜罐效应。所确定的法律和道德挑战涉及修改法律,使某些物质可以作为医疗控制的治疗选择,以及解决病人同意问题。负面的媒体报道和公众争议削弱了接受度,高昂的启动成本,特别是在安全、设施使用和经济可行性方面,被视为额外的障碍。监管障碍和严格的协议是患者和提供者最常提到的限制因素。促进者包括将试验处方纳入综合药物政策战略,并与确保遵守道德标准的伦理委员会一起发布数据以进行循证辩论。制定信息策略和解决对手的主张改善了公众的认知。研究发现,成本效益证据支持长期实施,而灵活的治疗方案、包容的空间和肯定的治疗关系被视为提高患者参与度和治疗效果的重要促进因素。结论:iOAT的成功实施需要平衡政治和社会可接受性与科学完整性,以及战略沟通和公众外展。需要进一步的研究来提高研究结果在不同社会政治背景下的可转移性,并解决与iOAT项目相关的关键影响因素。
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来源期刊
Harm Reduction Journal
Harm Reduction Journal Medicine-Public Health, Environmental and Occupational Health
CiteScore
5.90
自引率
9.10%
发文量
126
审稿时长
26 weeks
期刊介绍: Harm Reduction Journal is an Open Access, peer-reviewed, online journal whose focus is on the prevalent patterns of psychoactive drug use, the public policies meant to control them, and the search for effective methods of reducing the adverse medical, public health, and social consequences associated with both drugs and drug policies. We define "harm reduction" as "policies and programs which aim to reduce the health, social, and economic costs of legal and illegal psychoactive drug use without necessarily reducing drug consumption". We are especially interested in studies of the evolving patterns of drug use around the world, their implications for the spread of HIV/AIDS and other blood-borne pathogens.
期刊最新文献
Developing a comprehensive inventory to define harm reduction housing. Future destinations: how people cured of hepatitis C using direct acting antiviral drugs progress in a new HCV-free world. A thematic analysis. Opioid-related harms and experiences of care among people in justice settings in New South Wales, Australia: evidence from the National Ambulance Surveillance System. Reducing medical cannabis use risk among Veterans: A descriptive study. An exploration of desired abstinent and non-abstinent recovery outcomes among people who use methamphetamine.
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