In pursuit of harm reduction in the Alaskan context: patient cultural explanatory models of addiction and treatment outcomes for a medically-assisted program utilizing a buprenorphine/naloxone formulation

Abstract

This study explored the process of completing a private-for-profit medically-assisted treatment (MAT) program which treats opioid use disorder in a semi-rural community in Alaska. The goal of the study was to answer two broad research questions: (a) did patients get better during the medically-assisted treatment program, and (b) what characterized patient experiences participating in the MAT program? Limited research has been conducted to understand patient experiences of completing medically-assisted treatment in small communities and how various factors may impact treatment outcomes and recovery trajectories. To achieve this goal, a mixed methods case study approach was conducted to evaluate changes in symptom distress and characterize the experience of patients who participated in the program. Three Phases were implemented. Phase I involved archival data analysis of a 22 patient dataset was conducted to assess pre-post treatment outcomes. In Phase II three participants were interviewed who initiated in the program to explore patient treatment themes. Phase III involved co-interpretation of preliminary findings MAT program providers to synthesize findings and gain insights into systemic factors that may have impacted participant experiences. The three-phase research study revealed three major findings. First, MAT patient program completers in our sample who utilized buprenorphine/naloxone in conjunction with counseling experienced a statistically significant reduction in psychological distress with a large observed effect size (Phase I). Second, themes that emerged from semi-structured interviews suggest motivation and treatment process factors play an important role in treatment success (Phase II). Finally, community stakeholders on the provider treatment team were consulted to more deeply understand why it is important to assess patient needs and co-interpret key study findings (Phase III).