A Rapid-Cycle Assessment Strategy for Understanding the Opioid Overdose Epidemic in Local Communities

Abstract

Background Certain communities in the United States experience greater opioid-involved overdose mortality than others. Interventions to stem overdose benefit from contextual understandings of communities’ needs and strengths in addressing the opioid crisis. This project aims to understand multiple stakeholder perspectives on the opioid epidemic in communities disproportionately affected by opioid-involved overdose mortality. Methods We performed a rapid-cycle qualitative assessment study utilizing in-depth interviews with community stakeholders and observations of community meetings in eight communities in Allegheny County, Pennsylvania, USA, disproportionately impacted by opioid-involved overdose mortality. Stakeholder categories included: current and past illicit users of opioids; medical and social service providers; emergency medical services; law enforcement; spouse or other family members of illicit users/former users of opioids; government officials; school officials; community members. Content analysis was utilized to identify themes and answer study questions. Regular feedback to stakeholders was provided to support targeted interventions. Results We performed semi-structured, in-depth interviews with 130 community stakeholders and 29 community meeting observations in 2018–2019. Participants perceived similar economic and social determinants as origins of the opioid overdose epidemic including lack of economic resources, loss of jobs, transient populations and dilapidated housing. However, they differed in their awareness of and attention to the epidemic. Awareness was dependent on the visibility of opioid use (presence of paraphernalia litter, location of drug users, media coverage, and relationship to users). Overall, there was good knowledge of naloxone for opioid overdose reversal but less knowledge about local syringe services programs. Perceptions of harm reduction efforts were ambivalent. Conclusions Members of communities impacted by the opioid epidemic perceived that economic downturn was a major factor in the opioid overdose epidemic. However, the varied beliefs within and between communities suggest that interventions need to be tailored according to the cultural norms of place.

Provider Perceptions of Medication for Opioid Used Disorder (MOUD): A Qualitative Study in Communities with High Opioid Overdose Death Rates

“…This study team consisted of a multi-disciplinary group with expertise in anthropology, public health, and medicine. A leadership team of key county and city stakeholders met regularly with the study team to provide input, insights, and assistance 17 , 18 , 22 , 23 …”

“…This study was conducted as part of a larger rapid-cycle assessment ethnographic study of communities with disproportionately high opioid overdose death rates. [17][18][19][20][21] For the larger study, we set out to examine the beliefs, concerns, needs, strategies, and experiences of various stakeholder groups in Allegheny County, Pennsylvania, neighborhoods with high opioid-related overdose death rates. [17][18][19] This study team consisted of a multi-disciplinary group with expertise in anthropology, public health, and medicine.…”

“…[17][18][19][20][21] For the larger study, we set out to examine the beliefs, concerns, needs, strategies, and experiences of various stakeholder groups in Allegheny County, Pennsylvania, neighborhoods with high opioid-related overdose death rates. [17][18][19] This study team consisted of a multi-disciplinary group with expertise in anthropology, public health, and medicine. A leadership team of key county and city stakeholders met regularly with the study team to provide input, insights, and assistance.…”

“…Although other research has examined physician perceptions of MOUD, less is known about how community providers who provide services for persons with OUD – in professional roles ranging from healthcare to social services – perceive the benefits and drawbacks to patient treatment with MOUD 14 – 16 . We performed a sub-analysis of interviews collected from health and substance use service professionals as a part of the a larger ethnographic study examining neighborhoods with high opioid overdose rates in Allegheny County 17 , 18 . The objective of this analysis was to qualitatively explore attitudes, opinions, and beliefs of MOUD among healthcare and social service providers within these high risk communities of Allegheny County, Pennsylvania.…”

“…[14][15][16] We performed a sub-analysis of interviews collected from health and substance use service professionals as a part of the a larger ethnographic study examining neighborhoods with high opioid overdose rates in Allegheny County. 17,18 The objective of this analysis was to qualitatively explore attitudes, opinions, and beliefs of MOUD among healthcare and social service providers within these high risk communities of Allegheny County, Pennsylvania.…”