“As long as that place stays open, I’ll stay alive”: Accessing injectable opioid agonist treatment during dual public health crises
Abstract Background Since the onset of the COVID-19 pandemic, overdose rates in North America have continued to rise, with more than 100,000 drug poisoning deaths in the past year. Amidst an increasingly toxic drug supply, the pandemic disrupted essential substance use treatment and harm reduction s...
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-04-01
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| Series: | Harm Reduction Journal |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12954-023-00779-w |
| _version_ | 1797846031613820928 |
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| author | Kaitlyn Jaffe Sarin Blawatt Eisha Lehal Kurt Lock Adam Easterbrook Scott MacDonald Scott Harrison Julie Lajeunesse David Byres Martin Schechter Eugenia Oviedo-Joekes |
| author_facet | Kaitlyn Jaffe Sarin Blawatt Eisha Lehal Kurt Lock Adam Easterbrook Scott MacDonald Scott Harrison Julie Lajeunesse David Byres Martin Schechter Eugenia Oviedo-Joekes |
| author_sort | Kaitlyn Jaffe |
| collection | DOAJ |
| description | Abstract Background Since the onset of the COVID-19 pandemic, overdose rates in North America have continued to rise, with more than 100,000 drug poisoning deaths in the past year. 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. Methods Between April 2020 and February 2021, we conducted 51 interviews with 18 iOAT clients and two clinic nurses to understand how the pandemic shaped iOAT access and treatment experiences. To analyze interview data, we employed a multi-step, flexible coding strategy, an iterative and abductive approach to analysis, using NVivo software. Results Qualitative analysis revealed the ways in which the pandemic shaped clients’ lives and the provision of iOAT care. 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. Conclusion Participant narratives underscored the unequal distribution of pandemic impacts for people who use drugs but also highlighted opportunities for more flexible, patient-centered treatment approaches. Across treatment settings, pandemic-era changes that increase client autonomy and ensure equitable access to care are to be continued and expanded, beyond the duration of the pandemic. |
| first_indexed | 2024-04-09T17:49:35Z |
| format | Article |
| id | doaj.art-af7166c5477647c8a2a8842996b0e5fa |
| institution | Directory Open Access Journal |
| issn | 1477-7517 |
| language | English |
| last_indexed | 2024-04-09T17:49:35Z |
| publishDate | 2023-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Harm Reduction Journal |
| spelling | doaj.art-af7166c5477647c8a2a8842996b0e5fa2023-04-16T11:10:10ZengBMCHarm Reduction Journal1477-75172023-04-0120111210.1186/s12954-023-00779-w“As long as that place stays open, I’ll stay alive”: Accessing injectable opioid agonist treatment during dual public health crisesKaitlyn Jaffe0Sarin Blawatt1Eisha Lehal2Kurt Lock3Adam Easterbrook4Scott MacDonald5Scott Harrison6Julie Lajeunesse7David Byres8Martin Schechter9Eugenia Oviedo-Joekes10Center for Bioethics and Social Sciences in Medicine, University of MichiganCentre for Health Evaluation and Outcome Sciences, Providence Health Care, St. Paul’s HospitalCentre for Health Evaluation and Outcome Sciences, Providence Health Care, St. Paul’s HospitalCentre for Health Evaluation and Outcome Sciences, Providence Health Care, St. Paul’s HospitalCentre for Health Evaluation and Outcome Sciences, Providence Health Care, St. Paul’s HospitalProvidence Health Care, Providence Crosstown ClinicProvidence Health Care, Providence Crosstown ClinicProvidence Health Care, Providence Crosstown ClinicProvincial Health Services AuthorityCentre for Health Evaluation and Outcome Sciences, Providence Health Care, St. Paul’s HospitalCentre for Health Evaluation and Outcome Sciences, Providence Health Care, St. Paul’s HospitalAbstract Background Since the onset of the COVID-19 pandemic, overdose rates in North America have continued to rise, with more than 100,000 drug poisoning deaths in the past year. 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. Methods Between April 2020 and February 2021, we conducted 51 interviews with 18 iOAT clients and two clinic nurses to understand how the pandemic shaped iOAT access and treatment experiences. To analyze interview data, we employed a multi-step, flexible coding strategy, an iterative and abductive approach to analysis, using NVivo software. Results Qualitative analysis revealed the ways in which the pandemic shaped clients’ lives and the provision of iOAT care. 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. Conclusion Participant narratives underscored the unequal distribution of pandemic impacts for people who use drugs but also highlighted opportunities for more flexible, patient-centered treatment approaches. Across treatment settings, pandemic-era changes that increase client autonomy and ensure equitable access to care are to be continued and expanded, beyond the duration of the pandemic.https://doi.org/10.1186/s12954-023-00779-wInjectable opioid agonist treatmentCOVID-19 pandemicSubstance useCanada |
| spellingShingle | Kaitlyn Jaffe Sarin Blawatt Eisha Lehal Kurt Lock Adam Easterbrook Scott MacDonald Scott Harrison Julie Lajeunesse David Byres Martin Schechter Eugenia Oviedo-Joekes “As long as that place stays open, I’ll stay alive”: Accessing injectable opioid agonist treatment during dual public health crises Harm Reduction Journal Injectable opioid agonist treatment COVID-19 pandemic Substance use Canada |
| title | “As long as that place stays open, I’ll stay alive”: Accessing injectable opioid agonist treatment during dual public health crises |
| title_full | “As long as that place stays open, I’ll stay alive”: Accessing injectable opioid agonist treatment during dual public health crises |
| title_fullStr | “As long as that place stays open, I’ll stay alive”: Accessing injectable opioid agonist treatment during dual public health crises |
| title_full_unstemmed | “As long as that place stays open, I’ll stay alive”: Accessing injectable opioid agonist treatment during dual public health crises |
| title_short | “As long as that place stays open, I’ll stay alive”: Accessing injectable opioid agonist treatment during dual public health crises |
| title_sort | as long as that place stays open i ll stay alive accessing injectable opioid agonist treatment during dual public health crises |
| topic | Injectable opioid agonist treatment COVID-19 pandemic Substance use Canada |
| url | https://doi.org/10.1186/s12954-023-00779-w |
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