Clients’ experiences on North America’s first take-home injectable opioid agonist treatment (iOAT) program: a qualitative study

BMC Health Services Research

Research

Sophia Dobischok¹  José Carvajal¹  Eugenia Oviedo-Joekes²  Martin Schechter²  Piotr Klakowicz³  Murray Brown³  Cheryl McDermid³  Scott MacDonald³  Sam Gill³  Julie LaJeunesse³  Scott Harrison³  Nancy Chow³ 

[1] Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul’s Hospital, 575- 1081 Burrard St, V6Z 1Y6, Vancouver, BC, Canada;Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul’s Hospital, 575- 1081 Burrard St, V6Z 1Y6, Vancouver, BC, Canada;School of Population and Public Health, University of British Columbia, 2206 East Mall, V6T 1Z3, Vancouver, BC, Canada;Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, V6B 1G6, Vancouver, BC, Canada;

关键词: Injectable diacetylmorphine;    Injectable hydromorphone;    Take-home doses;    Opioid use disorder;    Person centered care;   

DOI  :  10.1186/s12913-023-09558-6

 received in 2023-03-14, accepted in 2023-05-16,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundTo support public health measures during the COVID-19 pandemic, oral opioid agonist treatment (OAT) take-home doses were expanded in Western countries with positive results. Injectable OAT (iOAT) take-home doses were previously not an eligible option, and were made available for the first time in several sites to align with public health measures. Building upon these temporary risk-mitigating guidelines, a clinic in Vancouver, BC continued to offer two of a possible three daily doses of take-home injectable medications to eligible clients. The present study explores the processes through which take-home iOAT doses impacted clients’ quality of life and continuity of care in real-life settings.MethodsThree rounds of semi-structured qualitative interviews were conducted over a period of seventeen months beginning in July 2021 with eleven participants receiving iOAT take-home doses at a community clinic in Vancouver, British Columbia. Interviews followed a topic guide that evolved iteratively in response to emerging lines of inquiry. Interviews were recorded, transcribed, and then coded using NVivo 1.6 using an interpretive description approach.ResultsParticipants reported that take-home doses granted them the freedom away from the clinic to have daily routines, form plans, and enjoy unstructured time. Participants appreciated the greater privacy, accessibility, and ability to engage in paid work. Furthermore, participants enjoyed greater autonomy to manage their medication and level of engagement with the clinic. These factors contributed to greater quality of life and continuity of care. Participants shared that their dose was too essential to divert and that they felt safe transporting and administering their medication off-site. In the future, all participants would like more accessible treatment such as access longer take-home prescriptions (e.g., one week), the ability to pick-up at different and convenient locations (e.g., community pharmacies), and a medication delivery service.ConclusionsReducing the number of daily onsite injections from two or three to only one revealed the diversity of rich and nuanced needs that added flexibility and accessibility in iOAT can meet. Actions such as licencing diverse opioid medications/formulations, medication pick-up at community pharmacies, and a community of practice that supports clinical decisions are necessary to increase take-home iOAT accessibility.

【 授权许可】

CC BY   
© The Author(s) 2023

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