Mayer Samara, Fairbairn Nadia, Fowler Al, Boyd Jade, Kerr Thomas, McNeil Ryan
Institute on Aging and Lifelong Health, University of Victoria, 3800 Finnerty Road, Victoria, BC, Canada, V8P 5C2.
Canadian Institute for Substance Use Research, University of Victoria, 3800 Finnerty Road, Victoria, BC, Canada, V8P 5C2.
Harm Reduct J. 2025 Jul 4;22(1):116. doi: 10.1186/s12954-025-01262-4.
Amidst a sustained drug poisoning crisis, there is growing recognition in Canada of the need to expand injectable opioid agonist treatment (iOAT). iOAT is an intensive treatment that involves the daily self-administration of hydromorphone or diacetylmorphine under healthcare provider supervision, typically accompanied by other health and social services. While this treatment has demonstrated effectiveness in reducing drug use-related risks, high threshold characteristics may also create barriers to engagement. This study examined patients' experiences of barriers and facilitators to iOAT with attention to how social and structural factors (e.g., housing vulnerability, poverty) shape program engagement.
This study draws on qualitative interviews and fieldwork observations with people accessing four iOAT programs in Vancouver's Downtown Eastside neighbourhood from May 2018 to November 2019. Data included baseline and follow-up interviews and approximately 50 h of observational fieldwork. Analysis leveraged a structural vulnerability lens to examine how social and structural factors shape people's engagement with iOAT.
Participants highlighted how improved access to health and social services, compassionate and relational care, and flexible and individualized approaches to treatment delivery that addresses and accounts for the structural vulnerabilities facilitated engagement in treatment. However, dosing supervision, operational capacity and medication formulation were experienced as barriers to treatment. These barriers were magnified by structural vulnerabilities such as housing instability and mobility challenges.
Study findings highlight how people navigate the barriers and facilitators to iOAT engagement in light of the structural vulnerabilities they experience. Adaptations to and ongoing support for iOAT programs may help to facilitate engagement and should focus on equity-oriented and patient- centered treatment models that includes the integration of social supports, support for relational care and treatment planning that supports patient autonomy.
在持续的药物中毒危机中，加拿大越来越认识到需要扩大注射用阿片类激动剂治疗（iOAT）。iOAT是一种强化治疗，包括在医疗保健提供者的监督下每日自行注射氢吗啡酮或二乙酰吗啡，通常还伴有其他健康和社会服务。虽然这种治疗已证明在降低与药物使用相关的风险方面有效，但高门槛特征也可能造成参与障碍。本研究调查了患者在接受iOAT治疗时遇到的障碍和促进因素，并关注社会和结构因素（如住房不稳定、贫困）如何影响项目参与。
本研究采用定性访谈和实地观察的方法，对2018年5月至2019年11月期间在温哥华市中心东区使用四个iOAT项目的人员进行了调查。数据包括基线和随访访谈以及约50小时的实地观察。分析利用了结构脆弱性视角，以研究社会和结构因素如何影响人们对iOAT的参与。
参与者强调，改善获得健康和社会服务的机会、富有同情心和建立关系的护理，以及灵活和个性化的治疗方式，这些方式能够解决并考虑到结构脆弱性，促进了对治疗的参与。然而，剂量监督、运营能力和药物配方被视为治疗的障碍。这些障碍因住房不稳定和行动挑战等结构脆弱性而加剧。
研究结果突出了人们如何根据自身所经历的结构脆弱性来应对iOAT参与中的障碍和促进因素。对iOAT项目的调整和持续支持可能有助于促进参与，应侧重于以公平为导向和以患者为中心的治疗模式，包括整合社会支持、支持建立关系的护理以及支持患者自主性的治疗规划。
