Factors influencing readiness to engage in substance use treatment among opioid overdose survivors in Boston, MA

Abstract

Background: There are significant gaps in receipt of addiction treatment following opioid overdoses in Boston, particularly among Black and Latinx overdose survivors. Previous research has established personal readiness as central in the decision to seek care among people who use substances. Especially due to high risk of repeated overdose in this population, improving treatment engagement necessitates an in-depth understanding of factors that may influence overdose survivors’ treatment readiness.

Methods: This qualitative study elicited overdose survivors’ perspectives on drug use, their recent overdose(s), and treatment experiences with a particular focus on racial equity. Between September 2020-21, we interviewed 59 people who had survived an opioid overdose in the preceding 3 months. We also interviewed 28 key informants (KIs) with relevant professional or community leadership roles.

Results: Overdose survivors (18 Black, 23 Latinx, and 18 White) described several factors impacting readiness, including mental energy required to find appropriate treatment, fear of opioid withdrawal symptoms, possibility of return to use (conceptualized as treatment failure), and desire for stability in housing or other social determinants in order to increase chances of treatment success. Several KIs expanded on this by linking self-worth and readiness to inaccessible systems (“How could I say I’m worth getting clean if I’m not even worth someone putting me in a home or giving me a job? ).

Implications: Addressing barriers to addiction treatment readiness, including how these barriers disproportionately impact Black and Latinx people, can help professionals and treatment systems more effectively engage and retain individuals at risk of repeated overdose.

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