Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), #2035-33 Ursula Franklin St, Toronto, Ontario, M5S 2S1, Canada.
Drug Users Advocacy League (DUAL), 216 Murray St, Ottawa, Ontario, K1N 5S6, Canada.
BMC Public Health. 2021 Nov 6;21(1):2021. doi: 10.1186/s12889-021-12104-w.
People who use drugs (PWUD) often have complex health and social support needs related to substance use, yet face numerous barriers to service access, resulting in unmet treatment needs and a corresponding gap in treatment. While initiatives to scale up substance use services for PWUD in Canada - and Ontario - have been undertaken, these have excluded PWUD' perspectives, and their needs have largely been defined by other actors. As end-users of services, PWUD' perspectives are vital to understanding what services are required, and whether existent services are adequate, appropriate and effective. Thus, the present study aimed to elicit in-depth knowledge from PWUD with lived experience of accessing services to better understand their unmet treatment and service needs, towards closing the service and treatment gap in Ontario.
This qualitative study included one-on-one interviews conducted with a cohort of n = 45 adult PWUD with substance use and treatment experience in Ontario, Canada. Participants were recruited from substance use services based on ConnexOntario's directory of all provincial addiction services, as well as by word-of-mouth. Questions focused on participants' experiences and perspectives on substance use services towards understanding their service needs. Data underwent an inductive thematic analysis based on key themes that emerged.
Participants commonly engaged in polysubstance use, and identified a number of unmet substance use service needs including complex factors within the current service system that influenced access to available programs. Specifically, participants suggested the need to address stigmatization and system fragmentation, increase service provision and capacity, and scale up specific services and related supports such as harm reduction, counseling, treatment, and housing.
This study identified PWUD' needs in relation to substance use service provision in Ontario, Canada, and highlighted important areas for policy change and program planning and implementation. Concrete recommendations include the development of a government-funded, low-barrier, comprehensive and integrated service delivery and referral models that include PWUD as collaborators and program facilitators to ensure that services are as accessible, effective, and cohesive as possible. Results from this study can be used to enhance provincial substance use treatment and service provision.
吸毒者（PWUD）通常有与药物使用相关的复杂健康和社会支持需求，但面临着许多服务获取障碍，导致治疗需求未得到满足，存在相应的治疗缺口。虽然加拿大——以及安大略省——已经采取了扩大吸毒者服务的举措，但这些举措排除了吸毒者的观点，他们的需求主要是由其他行为者定义的。作为服务的最终用户，吸毒者的观点对于了解需要哪些服务以及现有服务是否足够、适当和有效至关重要。因此，本研究旨在从有服务获取经验的吸毒者那里获取深入的知识，以更好地了解他们未满足的治疗和服务需求，从而缩小安大略省的服务和治疗差距。
这项定性研究包括对安大略省 45 名有吸毒和治疗经验的成年吸毒者进行的一对一访谈。参与者是根据 ConnexOntario 全省成瘾服务目录以及口碑从吸毒者服务机构招募的。问题集中在参与者对吸毒者服务的经验和观点，以了解他们的服务需求。数据根据出现的关键主题进行了归纳主题分析。
参与者普遍从事多种药物滥用，确定了一些未满足的药物使用服务需求，包括当前服务系统内影响获得现有方案的复杂因素。具体而言，参与者建议需要解决污名化和系统碎片化问题，增加服务提供和能力，扩大特定服务和相关支持，如减少伤害、咨询、治疗和住房。
本研究确定了加拿大安大略省吸毒者与药物使用服务提供有关的需求，并强调了政策变革和方案规划与实施的重要领域。具体建议包括制定一个由政府资助、低门槛、全面和综合的服务提供和转介模式，包括吸毒者作为合作者和方案促进者，以确保服务尽可能具有可及性、有效性和一致性。本研究的结果可用于加强省级药物使用治疗和服务提供。
