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. 2021 Feb 23;9(1):E115-E124.
doi: 10.9778/cmajo.20200021. Print 2021 Jan-Mar.

Service delivery models for injectable opioid agonist treatment in Canada: 2 sequential environmental scans

Erin Eydt  1 , Stephanie Glegg  1 , Christy Sutherland  1 , Karine Meador  1 , Michael Trew  1 , Michel Perreault  1 , Marie-Ève Goyer  1 , Bernard Le Foll  1 , Jeffrey Turnbull  1 , Nadia Fairbairn  1
Affiliations

Service delivery models for injectable opioid agonist treatment in Canada: 2 sequential environmental scans

Erin Eydt et al. CMAJ Open. .

Abstract

Background: 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.

Methods: 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.

Results: 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.

Interpretation: 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.

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Conflict of interest statement

Competing interests: Christy Sutherland reports family investment in Adamis Pharmaceuticals during the conduct of the study. Marie-Ève Goyer reports receiving an honorarium and training support from Gilead Sciences, outside of the submitted work. Bernard Le Foll reports receiving grants from Pfizer, BrainsWay, Bioprojet, Alkermes, Canopy Growth and the American Chemical Society, as well as nonfinancial support from Aurora Cannabis, outside the submitted work. Christy Sutherland, Karine Meador, Michael Trew, Jeffrey Turnbull and Nadia Fairbairn were involved in the clinical provision of injectable opioid agonist treatment during the conduct of the study. No other competing interests were declared.

Figures

Figure 1:
Figure 1:
Timeline of injectable opioid agonist treatment (iOAT) program start and end dates (where applicable).
See this image and copyright information in PMC

References

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