ABSTRACT
BACKGROUND: To support public health measures during the COVID-19 pandemic, oral opioid agonist treatment (OAT) take-home doses were expanded in Western countries with positive results. Injectable OAT (iOAT) take-home doses were previously not an eligible option, and were made available for the first time in several sites to align with public health measures. Building upon these temporary risk-mitigating guidelines, a clinic in Vancouver, BC continued to offer two of a possible three daily doses of take-home injectable medications to eligible clients. The present study explores the processes through which take-home iOAT doses impacted clients' quality of life and continuity of care in real-life settings. METHODS: Three rounds of semi-structured qualitative interviews were conducted over a period of seventeen months beginning in July 2021 with eleven participants receiving iOAT take-home doses at a community clinic in Vancouver, British Columbia. Interviews followed a topic guide that evolved iteratively in response to emerging lines of inquiry. Interviews were recorded, transcribed, and then coded using NVivo 1.6 using an interpretive description approach. RESULTS: Participants reported that take-home doses granted them the freedom away from the clinic to have daily routines, form plans, and enjoy unstructured time. Participants appreciated the greater privacy, accessibility, and ability to engage in paid work. Furthermore, participants enjoyed greater autonomy to manage their medication and level of engagement with the clinic. These factors contributed to greater quality of life and continuity of care. Participants shared that their dose was too essential to divert and that they felt safe transporting and administering their medication off-site. In the future, all participants would like more accessible treatment such as access longer take-home prescriptions (e.g., one week), the ability to pick-up at different and convenient locations (e.g., community pharmacies), and a medication delivery service. CONCLUSIONS: Reducing the number of daily onsite injections from two or three to only one revealed the diversity of rich and nuanced needs that added flexibility and accessibility in iOAT can meet. Actions such as licencing diverse opioid medications/formulations, medication pick-up at community pharmacies, and a community of practice that supports clinical decisions are necessary to increase take-home iOAT accessibility.
Subject(s)
COVID-19 , Opioid-Related Disorders , Humans , Analgesics, Opioid/therapeutic use , Pandemics , Quality of Life , COVID-19/epidemiology , British Columbia , Opioid-Related Disorders/drug therapy , Opioid-Related Disorders/prevention & controlABSTRACT
A rede transfronteiriça pode ser entendida como um processo de articulação e colaboração efetiva entre pesquisadores e instituições universitárias nos três países que formam a tríplice fronteira entre Brasil, Colômbia e Peru. O seu objetivo fundamental é sistematizar informações, pesquisar, monitorar e divulgar resultados sobre a pandemia de forma conjunta, ou seja, pensar nessas localidades e municípios fronteiriços dos três países como uma única região transfronteiriça. Essa perspectiva de pesquisa e análise dos dados visa romper com o nacionalismo metodológico tão presente nas pesquisas nas zonas fronteiriças internacionais. Isso coloca uma série de desafios na sistematização conjunta informação, à medida que as instituições de cada Estado-nação desenvolvem diferentes metodologias e diferentes prazos para publicação de dados oficiais, além de problemas de subnotificação em alguns casos. Essas dificuldades tornaram-se muito presentes no processo de produzir boletins de covid 19 na região, como evidenciado aqui durante a diálogo com os pesquisadores.Alternate : La red transfronteriza puede entenderse como un proceso de articulación y colaboración efectiva entre investigadores e instituciones universitarias de los tres países que forman la triple frontera entre Brasil, Colombia y Perú. Su objetivo fundamental es sistematizar información, investigar, monitorear y difundir los resultados de la pandemia de manera conjunta, es decir, pensar en estas localidades y municipios fronterizos de los tres países como una única región transfronteriza. Esta perspectiva de investigación y análisis de datos pretende romper con el nacionalismo metodológico tan presente en la investigación en zonas fronterizas internacionales. Esto plantea una serie de desafíos en la sistematización conjunta información, ya que las instituciones de cada Estado-nación desarrollan diferentes metodologías y diferentes plazos para la publicación de datos oficiales, además de los problemas de subregistro en algunos casos. Estas dificultades se hicieron muy presentes en el proceso de producir boletines de Covid-19 en la región, como se evidencia aquí durante el diálogo con investigadores.Alternate : The cross-border network can be understood as a process of effective articulation and collaboration between researchers and university institutions in the three countries that form the triple border between Brazil, Colombia, and Peru. Its fundamental objective is to systematize information, research, monitor, and publicize results on the pandemic in a joint way, that is, to think of these localities and border municipalities of the three countries as a single cross-border region. This perspective of research and data analysis aims to break with the methodological nationalism so present in research in international border areas. This poses a number of challenges in systematizing joint information, as the institutions of each nation-state develop different methodologies and different time frames for the publication of official data, in addition to problems of underreporting in some cases. These difficulties became very present in the process of producing bulletins from covid 19 in the region, as evidenced here during the dialogue with the researchers.