Barriers and facilitators to a novel low-barrier hydromorphone distribution program in Vancouver, Canada: a qualitative study

About: Study of the barriers and enablers of a tablet-based OAT program as an alternative to injectable OAT (TiOAT) using HDM for onsite oral, nasal or injectable use in Vancouver. Paired with an OPS, drug checking and iOAT program. Baseline & follow-up interviews and ethnographic observation of participants enrolled in the program yielded key facilitators: 1) A reliable source of opioids; 2) Co-location with the supervised consumption site (e.g. centrally located, already familiar; low-barrier relative to other SCS/OPS); and 3) Experiences of agency and program flexibility (e.g. come when they want, ok to return after time away; alternatives to injection). Barriers to engagement: 1) Operating hours and schedule; 2) Co-location with the OPS e.g. door locked during an overdose; wait times during peak hours; exposure to people not on treatment); 3) Generic hydromorphone (i.e. had chalky residue when crushed/cooked) and prescribed dose (i.e. too low for some). Contribution: Describes individual and system-level barriers and enablers of access from the perspective of people accessing the program. While designed within a medical model, it provides insights into safe supply programs that have similarities to this program’s relatively low-barrier approach.