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(wow) Words Of Wonders Level 385 Answers

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The East Carolinian, April 20, 1989

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Should I stay or should I go? A qualitative study of discrimination and other factors affecting opioid agonist treatment

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Victoria Rhys Carlisle 1, 2, *, Olivia M. Maynard 2, Darren Bagnall 1, Matthew Hickman 1, John Shorrock 3, Kayla Thomas 1 and Joanna Kesten 1, 4, 5

Avon & Wiltshire NHS Mental Health Trust, Drug and Alcohol Service Specialist, Colston Fort, Montague Place, Bristol BS6 5UB, United Kingdom

National Institutes of Health and Applied Medicine Western Research Collaboration (NIHR ARC West) University Hospitals Bristol and Weston NHS Foundation Trust, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1TL, England

National Health and Care Protection Research Institute (HPRU) Behavioral and Evaluative Sciences, University of Bristol, Bristol BS8 1TL, UK

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Received: 30 November 2022 / Revised: 9 January 2023 / Accepted: 11 January 2023

(1) Opioid agonist therapy has good reduction benefits of side effects. However, the UK government’s focus on ‘recovery’ may contribute to the low dropout and retention rates. We sought to develop a better and more nuanced understanding of the factors that influence the treatment of people using OAT. (2) We examined factors at various levels of the social system and considered the ways in which these interact to influence the therapeutic journey in OAT. We conducted semi-structured interviews with OAT users (n = 12) and service providers (n = 13) and analyzed the data using regression thematic analysis. (3) We developed three themes representing participants’ perceptions of the therapeutic journey in OAT. These are: (1) the system is broken; (2) measure power; (3) Filling the gap. (4) Conclusion: The data suggest the importance of prioritizing treatment to maintain the harm reduction benefits of OAT. Discrimination is a systemic problem that creates barriers to people living a fulfilling OAT life. There is an urgent need to develop targeted interventions to address discrimination against people who use OAT.

Opioid agonist therapy (OAT) is the first-line, evidence-based treatment for individuals seeking help for opioid addiction worldwide [1]. Treatment is based on the provision of methadone or buprenorphine, as well as psychosocial aspects such as crisis management or motivational interviewing [2]. Medicines used in OAT in the UK are usually collected from community pharmacies. In primary care, guidelines recommend medication intake to be monitored by a pharmacist (“supervised use”: [3]). OAT drugs have a longer half-life than heroin, meaning their effects last at least 24-36 hours. By eliminating the need to obtain and use heroin regularly, the main goal of OAT is to reduce and eliminate heroin and give people time and peace to deal with the psychological problems that lead to their addiction [4]. According to current UK government guidelines [5], OAT medications should not be stopped unless side effects occur or the current medication is not working well. In addition, people taking OATs should not be encouraged to reduce their medication during treatment. Instead, detoxification should only be done when people are ready to do so. Detoxification done in the community for about twelve weeks or in a clinic for 28 days is considered safe [5].

As a result of decreased drug use, OAT can be effective in reducing the spread of blood-borne viruses such as HIV and hepatitis C and reducing the risk of drug overdose. Adherence to OAT has also been associated with fewer hospitalizations for injection-related infections [11]. However, these benefits can be undermined by poor treatment and relapse to illicit opioid use. According to a recent systematic review of 67 studies, OAT retention rates were 57% at twelve months and only 38% at three years. Unless individuals died, were imprisoned, or were transferred to another location, treatment was “complete treatment” (). scheduled version) or “halt” (unscheduled version). ) ends in one of two ways. According to the UK Department of Health and Social Care [2], the aim of OAT is for individuals to progress from maintenance to detoxification and finally to cessation. However, in opioid therapy, the most common reason for abandonment is abandonment, and only 25% complete treatment [13]. This is evident in the Bristol area, where our previous work found that people who leave treatment are more likely to return to treatment in the future [14]. Therefore, retention is an important consideration in OAT, as “Cycling and Therapy” [15] puts individuals at greater risk than those who remain on long-term therapy. However, relapse at the start of treatment and immediately after treatment is different for methadone and buprenorphine, with the first week of treatment being the most dangerous time for people using methadone (but not buprenorphine) who are at high risk for all types of death and . addiction Relative toxicity, however, was associated with a higher risk for both OATs at four weeks after discharge [16].

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Despite the clear harm-reduction benefits of maintaining OAT programmes, the UK government’s current research-based drug strategy narrowly mentions harm-reduction programs that include OAT at record levels. Opioid deaths in this country [18]. Instead, the goal is to help more people “recover” from drug addiction. However, the word “recovery” is associated with cessation or “completion of treatment”. This is problematic because it can push people to detox from OAT drugs before they are produced and eventually return to illicit opioid use [19]. The approach to OAT in the UK has changed from long-term maintenance based on the principle of harm reduction, to treatment providers based on the number of successful “treatment completions” [20, 21]. Furthermore, the concept of recovery as a linear process with a binary outcome of success versus failure does not scientifically view addiction as a chronic, relapsing disease that requires management rather than “treatment.” Finally, there is a high consensus among addicts that recovery involves more than being free from the substance, but also includes improving relationships, housing, health, emotional stability, employment and reintegration into society. , 24, 25]. Importantly, all these results can be achieved within a long period of OAT (MAR: drug-assisted rehabilitation) and do not require drug detoxification.

One factor influencing OAT transport is polarization [ 26 , 27 , 28 , 29 , 30 , 31 ]. Discrimination can be considered “a highly degrading quality” [32] or “a set of unpleasant characteristics” [33]. The useful framework sees discrimination as three different forms: anticipatory discrimination (judgmental expectations or stereotypes), discrimination (direct action), and internal discrimination (driven by stereotypes and personal attitudes) [34, 35] .

The qualitative literature examining OAT experiences is extensive. However, these consider factors in isolation, such as fear [36]; social support [37]; or discrimination [26, 27, 28, 29, 30, 31]. The sociological approach allows the investigation of issues at five levels: individual, individual, organization, community, and political [38]. Similar models are used to investigate public health issues including opioid use and addiction (e.g. [ 39 , 40 , 41 , 42 , 43 , 44 ]). However, only a little

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