Sample Question Guide for MOAPC focus groups

Introduction, to be explained by the facilitator:

  • “During the next [hour] we will be discussing the opioid misuse problem in our communitiesin order to develop ways to address it.
  • You are the ones who really know the community. There are no right or wrong answers, give your honest opinions. If there are questions you are uncomfortable answering, we can skip them.
  • Throughout this discussion, I will be using the term “opioid.” An opioid is a substance that is a prescription medication (pill), andprescribed for pain relief. Heroin is also an opioid. Common opioid prescription pain relievers include OxyContin, Vicodin, and Percocet.
  • By keeping the groups small we hope that everyone will have a chance to speak. Please be respectful of the opinion of others.
  • We will keep the things that you sayanonymous. That means your name won’t be connected to what you said (unless we are worried about harm to yourself or others). When we report the results of this assessment, names will not be used. We will be taking notes during the focus group but your names will not be associated with your responses in any way.
  • Does anyone have any questions before we begin?

Definitions
What are opioids? / What is “opioid misuse”?
What are the consequences for opioid misuse?
  • Opioid is a broad term that encompasses both natural opiates obtained from the opium poppy plant and chemicals manufactured synthetically to have a chemical structure similar to that of an opiate.
  • Heroin is an opioid drug that is synthesized from morphine, a naturally occurring substance extracted from the seed pod of the Asian opium poppy plant. Heroin usually appears as a white or brown powder or as a black sticky substance, known as “black tar heroin.”
Some common Prescription Opioids (generic & brand names):
  • Fentanyl (Duragesic®)
  • Hydrocodone (Vicodin®)
  • Oxycodone (OxyContin®)
  • Oxymorphone (Opana®)
  • Propoxyphene (Darvon®)
  • Hydromorphone (Dilaudid®)
  • Meperidine (Demerol®)
  • Diphenoxylate (Lomotil®)
/
  • Opioid misuse:
  • A general term to encompass the use of illegal opioid drugs (e.g. heroin) and the misuse of prescription opioid medications (e.g. OxyContin).
  • Taking or being given a medication without a prescription (whether purchased illegally from a drug dealer or stolen from a friend or family member’s medicine cabinet).
  • Taking a prescribed medication for a purpose other than what the drug was prescribed for usually to elicit a particular experience or feeling.
  • “Double doctoring” (also called doctor shopping)—obtaining a prescription from more than one doctor without telling the prescribing doctor about other prescriptions received in the past 30 days.
  • Consequences for opioid misuse: the social, economic, and health problems associated with substance abuse (e.g. illnesses, overdose, crime and car crashes or suicides related to substance use).
  • Effects on the body: produce drowsiness, nausea, constipation and depending upon the amount of drug taken, depress respiration. These drugs also can induce euphoria by affecting the pleasure center of the brain. This feeling is often intensified for those who abuse opioids when administered through snorting or injecting.
  • Signs of opioid overdose: slow, shallow breathing, clammy skin, convulsions, respiratory depression and arrest (stop breathing), coma and death.
  • Anyone who misuses opioids is at risk of overdosing: It doesn’t matter if they are a new or experienced user or if they snort, inject or take pills.

Tips for facilitator

  • These are suggested questions. Choose and/or shape the questions that will best fit your community.
  • It is not necessary to ask all the questions listed below. The fewer the better (about 6-10 questions are recommended).
  • Use the probes (in parenthesis) to explore the opinions shared. It is not necessary to ask every probe listed.
  • Utilize a note taker who does not participate to quietly record the conversation and who may be seated in the back. Remember to remind participants that their last names will not be written down.

Introductions

  • First names
  • Brief ice breaker (how you heard about the focus group, favorite food or hobby, etc)

For ALL Groups

  • Have you noticed any trends in the use of drugs and alcohol in this area?
  • Have you noticed any changes in the use of opiates over time (pills and heroin)?
  • Is there anything about this community that you think makes it more likely for people to use opiates?
  • Is there anything that you think is working well to keep people from using opiates?
  • Can you think of anything else that could be done to prevent opiate use?

For Families of Users

•What stands out for you as you were/are dealing with a loved one with a substance use disorder?

•What response from others has been most helpful to you and your family? What response from others has been most difficult?

•If you or someone who was with you has ever overdosed, what were the circumstances around the overdose? (Probes: Did you know it was an OD? Did you know how to respond? What did you do?What was your experience with police/first responders?

•What has been your experience with Narcan? (Probes: Where did you get it? Where did you learn about it? Have you used it?)

  • What resources or support would be most helpful to you and your family?
  • What would be the best way to reach families like yours with information? (Probes: Who would you trust to bring you information?)
  • Do you have any ideas for what could be done to keep young people from first starting to use opiates?
  • Is there anything else that you think it’s important for us to know?

For Active Users

  • Have you noticed changes in availability?
  • How and where do you think people get pills or heroin?
  • If you or someone who was with you has ever overdosed, what were the circumstances around the overdose?
  • (Probes: If witness to an OD: Did you know it was an OD? Did you know how to respond? What did you do? What was your experience with police/first responders?)
  • (Probes: If you OD’d: did someone call 911? Did you go to the ER? Was there any discharge or follow up in the ER before you left? What was your experience with the police and first responders?)
  • What is your experience and/or knowledge about Narcan? (Do you know how to use it? Where did you get it? Have you ever used it before?)
  • Do you know about the Good Samaritan law (won’t get in trouble for calling 911 for someone else). Has this changed your calling or intent to call 911 or not?
  • What would be the best way to reach people who use pills or heroin with information? (Probes: Who would you trust to bring you information? Is there anyone that you would reach out to for help?)
  • Do you have any ideas for what could be done to keep young people from first starting to use pills or heroin? What would have prevented you from starting to pills or heroin?
  • Before we finish, is there anything else that you think it’s important for us to know?

For Treatment Providers

  • What opiates are your clients using? Are there any patterns or changes over time?
  • Based on what clients tell you, what do you think drives overdose?
  • What has been your experience with overdose in your workplace? (Probes: Did you know what to do? What did you do? What happened?)
  • What has been your experience with Narcan? (Probes: Has your agency provided training? Has it ever been used on a client? How has it affected your work? Do you know how to use it?)
  • Have you identified anything that helps people seek treatment?
  • What treatments do you see as most effective for opiate addiction? Why?
  • Is there anything else that you think it’s important for us to know?

For Youth/Teens

  • If you were to describe your friends and classmates in a few words, what words would you choose?
  • What are some of the things that you think your friends worry about?
  • Do you think your friends worry about drugs and alcohol? (Probes: What do they worry about specifically?)
  • Have you heard about students in your school using drugs (friends, classmates, friends of friends?)
  • What do you think are some reasons kids might try using drugs?
  • What drugs do you think are popular right now among people your age? (friends, classmates, friends of friends?)
  • If they are aware of drug use: Where and when do they use them? How do you think they get them? If pills, how do you think they get them?
  • What do you think about someone taking pills that another person’s doctor gave to them?
  • (Probes: Do you think some pills are safer than other pills? Which ones? What about pills compared to drugs and alcohol?)
  • (Probes: Do you know anyone who takes pills?Are people around you using them?)
  • If we could do one thing to prevent youth drug use/abuse, what should it be?
  • What didn’t we ask that we should have?

For Recovery Community

•How and where did you or people that you knew get pills or heroin? Have you noticed changes in availability?

•If you or someone who was with you has ever overdosed, what were the circumstances around the overdose?

  • (If witness to an OD: Did you know it was an OD? Did you know how to respond? What did you do? What was your experience with police/first responders?)
  • (If you OD’d: did someone call 911? Did you go to the ER? Was there any discharge or follow up in the ER before you left?
  • What is your experience with Narcan? (Probes: Who taught you? Do you or did you ever carry it? Where did you get it from?)
  • Do you know about the Good Samaritan law (won’t get in trouble for calling 911 for someone else)?(Probes: Has this changed your calling or intent to call 911 or not?)
  • What was your experiencewith the police and first responders?

•Are there things in this community that helped you and others in your recovery?

  • (What has been most helpful to you? What were the challenges?)

•What would be the best way to reach people who use pills or heroin with information? (Probe: Who would you trust to bring you information?)

  • Do you have any ideas for what could be done to keep young people from first starting to use opiates?
  • Before we finish, is there anything else that you think it’s important for us to know?

For Police and First Responders (EMT/Fire)

  • What has your experience been with people with substance use disorders?
  • Have you received any information or training regarding overdose and/or Narcan?
  • What has been your experience with people who were overdosing?(Probes: What happened? How did you come upon the person? How did you respond?)
  • What is your understanding of the Good Samaritan Law? (Probe: What do you think about it?How has it changed the way you do your job?)
  • Before we finish, is there anything else that you think it’s important for us to know?

For Emergency Department staff

•What has been your experience of working with patients who have or are overdosing?’

(challenges, successes, etc)

•What has your experience been with SBIRT?

•What is your experience with prescription monitoring (challenges, successes)

•What is your experience with discharge planning for overdose patients? (challenges, successes)

•Is there anything else that you think it’s important for us to know?

Other Potential Focus Groups:

  • Schools (adjustment counselors, etc)
  • Pharmacists (explore PMP)
  • Doctors (adult)and pediatricians(explore PMP)
  • Clergy
  • Courts/probation
  • Suboxone or methadone clients
  • Staff of Shelter and/or drop-in facilities

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