Characterizing intersystem and community values to enhance opioid use disorder treatments: Communities That Heal intervention in New York

Abstract

Background

In response to rising overdose deaths, the State of New York established multisystem coalitions in 16 counties to tackle the opioid crisis. These coalitions brought together stakeholders from various systems, including healthcare, behavioral health, criminal justice, and community-based services to address the epidemic in a coordinated community driven approach. The literature shows the implementation of effective, evidence-based community interventions is often hindered by differing values (attitudes, beliefs, and norms) between stakeholders of these coalitions and the communities where evidence-based approaches are implemented. This paper investigates how these divergent or shared values affect the implementation of naloxone and medications for opioid use disorder interventions.

Methods

We conducted a thematic analysis of semistructured interviews (n = 43) with coalition members representing multiple systems across eight New York counties. The analysis was guided by Interorganizational Relations and Resource Dependence Theories to examine how differing or shared values influenced the implementation of community-based opioid use disorder interventions.

Results

Five themes emerged on how divergent or shared intersystem and community values affected OUD interventions: a) shared values among coalition systems, b) divergent values between coalition systems, c) community education and destigmatization efforts, d) moral culpability of people who use opioids (PWUO), and e) value judgments of moral worthiness.

Conclusions

Aligning values across systems and communities is crucial for effectively implementing community-based interventions aimed at combating the opioid epidemic. Shifting systemic and community narratives from value judgments of moral worthiness and the moral culpability of PWUO to recognizing OUD as a chronic health disorder is key to achieving this alignment. Central to this effort are community education and destigmatization campaigns, which play a pivotal role in promoting a unified multisystem-community approach.