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

• Published in: BMC health services research Vol. 23; no. 1; pp. 553 - 16
• Main Authors: Oviedo-Joekes, Eugenia, Dobischok, Sophia, Carvajal, José, MacDonald, Scott, McDermid, Cheryl, Klakowicz, Piotr, Harrison, Scott, LaJeunesse, Julie, Chow, Nancy, Brown, Murray, Gill, Sam, Schechter, Martin
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 26-05-2023; BioMed Central; BMC
• Subjects: Access; Addictions; Analgesics, Opioid - therapeutic use; Autonomy; British Columbia; Clients; Community; Continuity of care; COVID-19; COVID-19 - epidemiology; Dosage and administration; Drug addiction; Drug dosages; Drug overdose; Drug stores; Drugs; Fentanyl; Health care; Health services; Heroin; Humans; Hydromorphone; Injectable diacetylmorphine; Injectable hydromorphone; Interviews; Medical decision making; Methadone; Morphine; Narcotics; Opioid use disorder; Opioid-Related Disorders - drug therapy; Opioid-Related Disorders - prevention & control; Opioids; Oral administration; Pandemics; Patient-centered care; Person centered care; Pharmacy; Prescriptions; Privacy; Public health; Public safety; Qualitative research; Quality of Life; Social workers; Take-home doses; Testing; British Columbia; Canada; United Kingdom > UK; United States > US; North America; Person centered care; Opioid use disorder; Injectable hydromorphone; Take-home doses; Injectable diacetylmorphine
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/s12913-023-09558-6

To 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.
Three 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.
Participants 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.
Reducing 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.