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      Identifying facilitators and barriers to the uptake of medication for opioid use disorder in Washington, DC: A community-engaged concept mapping approach

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          Abstract

          Introduction

          Opioid overdose is a major public health challenge. We aimed to understand facilitators and barriers to engagement in medication for opioid use disorder (MOUD) among persons with OUD in Washington, DC.

          Methods

          We used a cross-sectional mixed-methods concept mapping approach to explore MOUD engagement between 2021–2022. Community members at-large generated 70 unique statements in response to the focus prompt: “What makes medication for opioid use disorder like buprenorphine (also known as Suboxone or Subutex) difficult to start or keep using?” Persons with OUD (n = 23) and service providers (n = 34) sorted and rated these statements by theme and importance. Data were analyzed with multidimensional scaling and hierarchical cluster analysis, producing thematic cluster maps. Results were validated by our community advisory board.

          Results

          Seven themes emerged in response to the focus prompt: availability and accessibility; hopelessness and fear; unmet basic needs; characteristics of treatment programs; understanding and awareness of treatment; personal motivations, attitudes, and beliefs; and easier to use drugs. “Availability and accessibility,” “hopelessness and fear,” and “basic needs not being met” were the top three identified barriers to MOUD among consumers and providers; however, the order of these priorities differed between consumers and providers. There was a notable lack of communication and programming to address misconceptions about MOUD’s efficacy, side effects, and cost. Stigma underscored many of the statements, showcasing its continued presence in clinical and social spaces.

          Conclusions

          This study distinguishes itself from other research on MOUD delivery and barriers by centering on community members and their lived experiences. Findings emphasize the need to expand access to treatment, dismantle stigma associated with substance use and MOUD, and address underlying circumstances that contribute to the profound sense of hopelessness and fear among persons with OUD–all of which will require collective action from consumers, providers, and the public.

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          Most cited references51

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          Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence

          Cochrane Database of Systematic Reviews
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            Opioid Crisis: No Easy Fix to Its Social and Economic Determinants

            The accepted wisdom about the US overdose crisis singles out prescribing as the causative vector. Although drug supply is a key factor, we posit that the crisis is fundamentally fueled by economic and social upheaval, its etiology closely linked to the role of opioids as a refuge from physical and psychological trauma, concentrated disadvantage, isolation, and hopelessness. Overreliance on opioid medications is emblematic of a health care system that incentivizes quick, simplistic answers to complex physical and mental health needs. In an analogous way, simplistic measures to cut access to opioids offer illusory solutions to this multidimensional societal challenge. We trace the crisis’ trajectory through the intertwined use of opioid analgesics, heroin, and fentanyl analogs, and we urge engaging the structural determinants lens to address this formidable public health emergency. A broad focus on suffering should guide both patient- and community-level interventions.
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              Concept Mapping for Planning and Evaluation

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                Author and article information

                Contributors
                Role: Data curationRole: Formal analysisRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: SupervisionRole: Writing – review & editing
                Role: ConceptualizationRole: Writing – review & editing
                Role: ConceptualizationRole: Writing – review & editing
                Role: ConceptualizationRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: SupervisionRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                PLOS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                19 July 2024
                2024
                : 19
                : 7
                : e0306931
                Affiliations
                [1 ] Department of Prevention and Community Health, George Washington University Milken Institute School of Public of Health, Washington, DC, United States of America
                [2 ] Department of Epidemiology, George Washington University Milken Institute School of Public of Health, Washington, DC, United States of America
                [3 ] Family and Medical Counseling Services, Inc., Washington, DC, United States of America
                [4 ] HIPS, Washington, DC, United States of America
                [5 ] Whitman-Walker Health, Washington, DC, United States of America
                [6 ] Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, United States of America
                Sao Paulo State University (UNESP), Botucatu Medical School, BRAZIL
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                https://orcid.org/0009-0004-9825-9850
                https://orcid.org/0009-0007-3241-9198
                https://orcid.org/0000-0001-9240-1212
                Article
                PONE-D-23-41768
                10.1371/journal.pone.0306931
                11259286
                39028730
                255bf04c-3d83-4ed7-945a-d359ff87dde8
                © 2024 Gullahorn et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 15 December 2023
                : 25 June 2024
                Page count
                Figures: 2, Tables: 2, Pages: 18
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/100015466, Milken Institute School of Public Health, George Washington University;
                Award ID: Faculty Research Innovation Award
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/100000060, National Institute of Allergy and Infectious Diseases;
                Award ID: UG3/UH3AI169655
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/100000026, National Institute on Drug Abuse;
                Award ID: R01DA056264
                Award Recipient :
                No Grant Number Tamara Taggart and Irene Kuo George Washington University Milken Institute School of Public Health Faculty Research Innovation Award URL: None UG3/UH3AI169655 Tamara Taggart and Jonathon Rendina (MPI) National Institute of Allergy and Infectious Disease (NIAID) TT URL: https://www.niaid.nih.gov/ R01DA056264 Tamara Taggart and Nisha O’Shea (MPI) National Institute on Drug Abuse TT URL: https://nida.nih.gov/ The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine and Health Sciences
                Pharmaceutics
                Drug Therapy
                Medicine and Health Sciences
                Pharmacology
                Drugs
                Analgesics
                Opioids
                Medicine and Health Sciences
                Pain Management
                Analgesics
                Opioids
                Medicine and Health Sciences
                Pharmacology
                Drugs
                Opioids
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Mental Health Therapies
                Medicine and Health Sciences
                Pharmaceutics
                Drug Therapy
                Neurological Drug Therapy
                Anti-Addiction Drug Therapy
                Biology and Life Sciences
                Psychology
                Addiction
                Drug Addiction
                Social Sciences
                Psychology
                Addiction
                Drug Addiction
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Substance-Related Disorders
                Drug Addiction
                Medicine and Health Sciences
                Public and Occupational Health
                Substance-Related Disorders
                Drug Addiction
                Medicine and Health Sciences
                Urology
                Medicine and Health Sciences
                Public and Occupational Health
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Custom metadata
                All relevant data are within the manuscript--see Table 2.

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                Uncategorized

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