“As long as that place stays open, I’ll stay alive”: Accessing injectable opioid agonist treatment during dual public health crises

Original research
by
Jaffe, Kaitlyn et al

Release Date

2023

Geography

Canada

Language of Resource

English

Full Text Available

Yes

Open Access / OK to Reproduce

Yes

Peer Reviewed

Yes

Objective

Amidst an increasingly toxic drug supply, the pandemic disrupted essential substance use treatment and harm reduction services that reduce overdose risk for people who use drugs. In British Columbia, one such treatment is injectable opioid agonist treatment (iOAT), the supervised dispensation of injectable hydromorphone or diacetylmorphine for people with opioid use disorder. While evidence has shown iOAT to be safe and effective, it is intensive and highly regimented, characterized by daily clinic visits and provider–client interaction—treatment components made difficult by the pandemic.

Findings/Key points

First, client narratives illuminated how the pandemic reinforced existing inequities. For example, socioeconomically marginalized clients expressed concerns around their financial stability and economic impacts on their communities. Second, clients with health comorbidities recognized how the pandemic amplified health risks, through potential COVID-19 exposure or by limiting social connection and mental health supports. Third, clients described how the pandemic changed their engagement with the iOAT clinic and medication. For instance, clients noted that physical distancing guidelines and occupancy limits reduced opportunities for social connection with staff and other iOAT clients. However, pandemic policies also created opportunities to adapt treatment in ways that increased patient trust and autonomy, for example through more flexible medication regimens and take-home oral doses.

Design/methods

51 interviews with 18 iOAT clients and two clinic nurses

Keywords

About PWUD
Substitution/OAT
Barriers and enablers
Equity