Delivering opioid use disorder treatment among American Indian and Alaska Native adults during the COVID-19 pandemic and beyond: Facilitators and barriers to care.
Katherine A Hirchak, Kelsey Bajet, Meenakshi Richardson, Beverly Keyes, Racquel Shaffer, Karen Anderson Oliver, Frankie K Kropp, Aimee N C Campbell, Kamilla L Venner
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Abstract
Background: American Indian and Alaska Native (AI/AN) communities experienced a disproportionate increase in opioid-related fatal and non-fatal poisonings during the COVID-19 pandemic. Access to treatment, such as medications for opioid use disorder (MOUD), became even more critical, although research among this population is limited. We completed qualitative interviews with substance use disorder (SUD) treatment providers (i.e., MOUD prescribers, non-prescribing clinicians, non-clinical support staff) to assess the impact of COVID-19 on MOUD care among AI/AN adults.
Methods: Sixty-minute semi-structured interviews were completed with providers working in SUD treatment (N = 25). Eligible providers represented 6 programs serving rural Tribal and urban areas primarily in the Pacific Northwest United States. Transcripts were independently reviewed and analyzed for themes based upon the research aims.
Results: Nineteen female and six male providers completed interviews. Four themes were identified: (1) Beneficial policy changes for MOUD delivery; (2) Telehealth as the biggest policy shift; (3) Addressing complexity, and (4) Cultural services. Findings indicated providers viewed the introduction of telehealth, implementation of mobile services, and expanded take home dosing as positive and leading to increased treatment access. However, barriers related to the internet, transportation, and reimbursement of telehealth remain.
Conclusions: Providers highlighted the utility in the expansion and sustainment of telehealth. Flexible policies for MOUD were particularly beneficial during the height of COVID-19 to maintain and increase access to treatment. Providing a menu of treatment options, emphasizing cultural engagement and social support were deemed necessary to enhance AI/AN community driven solutions in curbing the opioid poisoning public health crisis.
期刊介绍：
The Journal of Ethnicity in Substance Abuse presents rigorous new studies and research on ethnicity and cultural variation in alcohol, tobacco, licit and illicit forms of substance use and abuse. The research is drawn from many disciplines and interdisciplinary areas in the social and behavioral sciences, public health, and helping professions. The Journal of Ethnicity in Substance Abuse is an international forum for identification of emergent and culturally diverse substance use and abuse trends, and the implementation of culturally competent strategies in harm reduction, individual, group, and family treatment of substance abuse. The Journal systematically investigates the beliefs, attitudes, and values of substance abusers, searching for the answers to the origins of drug use and abuse for different ethnic groups. The Journal publishes research papers, review papers, policy commentaries, and conference proceedings. The Journal welcomes submissions from across the globe, and strives to ensure efficient review and publication outcomes.
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