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Heroin Addiction and Related Clinical Problems: 2022, 24, N6 (pages: 51 - 55)

Problem Tree Force Field Analysis of injection of opioid agonist therapy and benzodiazepines in North Macedonia

Ignjatova L.A.

Summary: Introduction: The aim of this paper is to analyze the roots and effects of injection of opioid ago-nist therapy (OAT) and benzodiazepines by many patients participating in an OAT program and the factors involved both for and against the proposed change for solving this problem. Methods: For this purpose, we used Problem Tree Force Field analysis. "Problem Tree" was used to identify the focal problem and the associated causes and effects with the aim of identifying solutions to the problem by mapping out the anatomy of these causes and their effects. By rephrasing each of the problems into desirable outcomes, root causes and consequences are turned into solutions. Goals for change were then set in the "Force Field Analysis" to identify the factors and subse-quent pressures for and against the proposed change. Results: The analysis showed that the black market near the OAT service and the opportunity to sell take home therapy providing both financ-ing and "borrowed therapy" with "interest", aggravating poverty, unemployment, non-integration into the community, lack of social support, incoherent harm reduction interventions, exchange of injection equipment in front of the service, lack of education of out-reach workers and lack of staff are just some of the reasons for abuse and diversion of the OAT. This leads to a poor treatment outcome with the resulting consequences for patient health, staff, and the environment and which contributes to violence and stigma making recovery unlikely. Drivers and resistors are also analyzed, which help in visualizing the possibilities for achieving the proposed change and to determine which decisions and actions are needed and available. Conclusion: This tool shows the reality and helps to find solutions. New formulations of OAT can be one of the solutions to the diversion and abuse of OAT.