(WITHDRAWN) Opioid Misuse and Addiction Among Domestic Violence (DV) Victims in Shelters: Experiences of DV Service Providers

Background: Opioid use among survivors of domestic violence (DV) is an escalating concern that significantly threatens the well-being of DV survivors and their families. Because of the increasing prevalence of opioid use and addiction among DV survivors, DV shelters are consequently faced with new challenges in working with opioid-using survivors. However, little is known about the challenges DV residential programs face when working with opioid-using survivors and the types of support needed in these agencies to better address opioid issues in service provision. The primary objectives of this study were to assess service providers’ perspectives about: (1) opioid abuse and experiences of overdose among DV survivors residing in DV shelters, and (2) the specific challenges that DV residential programs encounter when working with survivors using opioids.  Methods: Data were gathered for this qualitative study through focus group discussions (N=7). Participants included a statewide, purposive sample of DV shelter staff members (N=55) from both rural and urban locations. A semi-structured interview guide was used to guide the focus groups Focus group discussions were audio-recorded and professionally transcribed. Four researchers analyzed the transcripts using coding and thematic development. Results: Three primary themes emerged: (a) barriers to providing optimal care to survivors with opioid addiction, (b) helpful approaches to successfully meeting survivor needs, and (c) staff member concerns about working with opioid-using survivors. Staff identified myriad barriers to providing optimal care to survivors, such as the inability to provide detox services, long waitlists or lack of capacity at substance abuse treatment centers, and insufficient resources (e.g. transportation, inadequate staffing, and lack of childcare). Staff identified that managing addiction concerns was a priority when providing services to survivors. Attending to opioid abuse issues left staff often unable to address the DV-related needs of a survivor (e.g. safety planning, psychoeducation, employment, etc.). Despite these challenges, staff identified helpful approaches for addressing opioid use in shelters. Harm reduction approaches, intentional and collaborative relationships with community agencies, team-based approaches, and behavior plans that incorporated client-centered goals were all perceived to be conducive strategies that facilitated improved service provision. Staff members also identified concerns about working with opioid-using survivors. Primary concerns included: inadequate training, insufficient resources, and their personal safety. Staff struggled to determine how to provide the best quality of care for survivors when the needs of opioid-using survivors conflicted with the needs of other survivors. Although staff wanted to provide autonomy to survivors to help empower them in the aftermath of DV, there was, sometimes, a perceived need to restrict certain behaviors or privileges such as access to prescription drugs in order to protect survivors. Conclusions/Implications. Results illuminate opioid abuse and overdose experiences among DV survivors in shelters and the specific struggles staff encounter while addressing this issue. The severity of opioid use in shelters is interfering with service providers’ ability to address DV-related issues. These findings will contribute towards research on opioid use among DV survivors and the development of program recommendations on addressing the burden of opioid use among DV survivors accessing residential services.