Browsing by Author "Monico, Laura"
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Item Situating agency within structure: the influence of autonomy and opportunity structure on drug users' routes of administration(University of Delaware, 2011) Monico, LauraCurrent drug treatment services largely neglect the importance of how people administer drugs as a central component of the drug-using process. With the exception of intravenous drug use, which has been studied primarily in terms of the risk it poses for blood-borne disease transmission, research on routes of drug administration is virtually absent from the extensive literature on drug use, abuse, and treatment in the United States. This study examines the relationship between individual autonomy and the availability of opportunities to use drugs on drug users' preferred route of administration. This project uses secondary data from the Drug Abuse Treatment Outcome Studies (DATOS) to investigate factors that influence which route of administration -- inhalation, smoking, or injecting -- is preferred by cocaine and heroin users.Item A systems perspective of buprenorphine patients' experiences in an opioid treatment program(University of Delaware, 2016) Monico, LauraThere is a significant gap between the treatment need of individuals in the United States with opioid use disorders and the treatment capacity to offer methadone or buprenorphine-based pharmacotherapy. This dissertation utilizes an ecological systems framework to explore buprenorphine patients’ experiences in an opioid treatment program, and discover potential barriers to patients’ treatment entry and engagement. Data comes from semi-structured qualitative interviews (n=20) with buprenorphine patients receiving daily medication doses in an opioid treatment program modality. Findings indicate a continued paradigmatic division between the criminalization and medicalization of opioid use disorders that filters down through ecological systems levels to create policy inconsistencies and individual treatment entry and engagement barriers. These findings contribute to existing research that has sought to understand the opioid treatment gap from the perspective of physicians and treatment organizations, by including patient perspectives of barriers limiting accessibility to buprenorphine. The results of this research project encourage the development of innovative strategies and interventions to improve the accessibility of buprenorphine in a treatment system that significantly improved its availability in recent years.