British Columbia Centre on Substance Use (Eydt, Glegg, Sutherland, Fairbairn); Department of Medicine (Glegg, Fairbairn), University of British Columbia, St. Paul's Hospital; Department of Family Medicine (Sutherland), University of British Columbia; PHS Community Services Society (Sutherland), Vancouver, BC; Alberta Health Services (Meador), Royal Alexandra Hospital; Department of Family Medicine (Meador), University of Alberta, Edmonton, Alta.; Alberta Health Services (Trew), Foothills Medical Centre; Department of Psychiatry (Trew), University of Calgary, Calgary, Alta.; Department of Psychiatry (Perreault), McGill University; Douglas Hospital Research Centre (Perreault); Department of Family Medicine (Goyer), University of Montreal, Montréal, Que.; Centre for Addiction and Mental Health (Le Foll), Toronto, Ont.; Ottawa Inner City Health (Turnbull), Ottawa, Ont.
CMAJ Open. 2021 Feb 23;9(1):E115-E124. doi: 10.9778/cmajo.20200021. Print 2021 Jan-Mar.
Injectable opioid agonist treatment (iOAT) is an emerging evidence-based option in the continuum of care for opioid use disorder in parts of Canada. Our study objective was to identify and describe iOAT programs operating during the ongoing opioid overdose crisis.
We conducted 2 sequential environmental scans. Programs were eligible to participate if they were in operation as of Sept. 1, 2018, and Mar. 1, 2019. Information was collected over 2-3 months for each scan (September-October 2018, March-May 2019). Programs that participated in the first scan and newly established programs were invited to participate in the second scan. The scans included questions about location, service delivery model, clinical and operational characteristics, numbers and demographic characteristics of clients, and program barriers and facilitators. Descriptive analysis was performed.
We identified 14 unique programs across the 2 scans. Eleven programs located in urban centres in British Columbia and Ontario participated in the first scan. At the time of the second scan, 2 of these programs were on hold and 2 of 3 newly established programs were in Alberta. The total capacity of all participating programs was 420 clients at most. Four service delivery models were identified; iOAT was most commonly integrated within existing health and social services. All programs offered hydromorphone, and 1 program also offered diacetylmorphine. In the first scan, 73% of clients (133/183) were male; the mean age of clients was 47 years. Limited capacity, pharmacy operations and lack of diacetylmorphine access were among the most frequently reported barriers. The most commonly reported facilitators included client-centred care, client relationships and access to other health and social support.
Evidence indicates that iOAT can be successfully implemented using diverse service delivery models. Future work should facilitate scale-up of this evidence-based treatment where gaps persist in high-risk communities.
在加拿大部分地区，注射类阿片激动剂治疗（iOAT）作为一种新兴的循证选择，已被纳入阿片类药物使用障碍的连续护理中。我们的研究目的是确定并描述在当前阿片类药物过量危机期间运行的 iOAT 项目。
我们进行了两次连续的环境扫描。如果项目在 2018 年 9 月 1 日和 2019 年 3 月 1 日期间运行，则有资格参与。每次扫描（2018 年 9 月至 10 月，2019 年 3 月至 5 月）收集信息的时间为 2-3 个月。参与第一次扫描的项目和新成立的项目被邀请参加第二次扫描。扫描包括关于地点、服务提供模式、临床和运营特征、客户数量和人口统计学特征以及项目障碍和促进因素的问题。进行了描述性分析。
我们在两次扫描中确定了 14 个独特的项目。第一次扫描有 11 个项目位于不列颠哥伦比亚省和安大略省的城市中心。在第二次扫描时，其中两个项目暂停，三个新成立的项目中的两个在艾伯塔省。所有参与项目的最大容量为 420 名客户。确定了四种服务提供模式；iOAT 最常见的是整合在现有的卫生和社会服务中。所有项目均提供氢吗啡酮，其中一个项目还提供二乙酰吗啡。在第一次扫描中，73%的客户（133/183）为男性；客户的平均年龄为 47 岁。容量有限、药房运营以及缺乏二乙酰吗啡获取途径是报告最多的障碍。报告最多的促进因素包括以客户为中心的护理、客户关系以及获得其他卫生和社会支持。
证据表明，使用不同的服务提供模式可以成功实施 iOAT。在高危社区仍存在差距的情况下，未来的工作应该促进这种循证治疗的扩大。
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