Implementing injectable opioid agonist treatment: a survey of professionals in the field of opioid use disorders

Abstract Background Engagement of health care professionals represents an important factor for successful implementation of new practices. To support these professionals’ involvement, it is essential to understand their perspective. This study describes the perspective of professionals in the field of opioid use disorder (OUD), in the province of Quebec (Canada), regarding appropriateness of iOAT for their patients and the obstacles to its implementation. Methods A web-based survey was conducted, with 132 OUD professionals (physicians, pharmacists, nurses and counselors). Results 80.3% of respondents report prior knowledge of iOAT, 87.6% are interested in obtaining additional information on iOAT, and 98.1% consider iOAT to be very or partially appropriate for their clientele. In terms of barriers to iOAT implementation, the main obstacles highlighted by respondents pertain to the lack of available or qualified staff, access to appropriate facilities and equipment, and patient transportation. Professionals who perceive iOAT to be very appropriate for their clientele are more likely to report a higher number of patients with biopsychosocial deterioration, to consider themselves to be very familiar with iOAT, and to work in a higher population density area. Conclusions Results highlight feasibility challenges, but support perceived appropriateness of iOAT in a sample of OUD professionals in Quebec.

[1]  E. Mpofu,et al.  Sustainable Harm Reduction Needle and Syringe Programs for People Who Inject Drugs: A Scoping Review of Their Implementation Qualities , 2021, Sustainability.

[2]  S. Glegg,et al.  Service delivery models for injectable opioid agonist treatment in Canada: 2 sequential environmental scans , 2021, CMAJ open.

[3]  E. Oviedo-Joekes,et al.  Take home injectable opioids for opioid use disorder during and after the COVID-19 Pandemic is in urgent need: a case study , 2020, Substance Abuse Treatment, Prevention, and Policy.

[4]  F. Boland,et al.  Retention of patients in opioid substitution treatment: A systematic review , 2020, PloS one.

[5]  W. Katzman,et al.  Barriers to and recommendations for take-home naloxone distribution: perspectives from opioid treatment programs in New Mexico , 2020, Harm Reduction Journal.

[6]  Pierre Smith,et al.  How to overcome political and legal barriers to the implementation of a drug consumption room: an application of the policy agenda framework to the Belgian situation , 2019, Addiction Science & Clinical Practice.

[7]  T. Watson,et al.  Losing the uphill battle? Emergent harm reduction interventions and barriers during the opioid overdose crisis in Canada. , 2019, The International journal on drug policy.

[8]  B. Fischer,et al.  The opioid death crisis in Canada: crucial lessons for public health. , 2019, The Lancet. Public health.

[9]  Allison J. Ober,et al.  Considering Heroin-Assisted Treatment and Supervised Drug Consumption Sites in the United States: , 2018 .

[10]  J. Bell,et al.  Supervised Injectable Opioid Treatment for the Management of Opioid Dependence , 2018, Drugs.

[11]  N. Bansback,et al.  Cost‐effectiveness of hydromorphone for severe opioid use disorder: findings from the SALOME randomized clinical trial , 2018, Addiction.

[12]  H. Thiede,et al.  Utilization of Buprenorphine and Methadone among Opioid users who Inject Drugs , 2018, Substance abuse.

[13]  J. Eibl,et al.  The State of Opioid Agonist Therapy in Canada 20 Years after Federal Oversight , 2017, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[14]  R. Chou,et al.  Medication-Assisted Treatment Models of Care for Opioid Use Disorder in Primary Care Settings , 2016 .

[15]  M. Stein,et al.  Buprenorphine Initiation and Linkage to Outpatient Buprenorphine do not Reduce Frequency of Injection Opiate Use Following Hospitalization. , 2016, Journal of substance abuse treatment.

[16]  M. Schechter,et al.  Hydromorphone Compared With Diacetylmorphine for Long-term Opioid Dependence: A Randomized Clinical Trial. , 2016, JAMA psychiatry.

[17]  C. Wilder,et al.  Barriers to Implementation of Opioid Overdose Prevention Programs in Ohio , 2016, Substance abuse.

[18]  J. Bell,et al.  Heroin on trial: Systematic review and meta-analysis of randomised trials of diamorphine-prescribing as treatment for refractory heroin addiction , 2015, British Journal of Psychiatry.

[19]  H. Connery.  Medication-Assisted Treatment of Opioid Use Disorder: Review of the Evidence and Future Directions , 2015, Harvard review of psychiatry.

[20]  M. Stein,et al.  Differential Risk Factors for HIV Drug and Sex Risk-Taking Among Non-treatment-seeking Hospitalized Injection Drug Users , 2015, AIDS and Behavior.

[21]  A. Vandal,et al.  Estimating the size of the population of persons who inject drugs in the island of Montréal, Canada, using a six-source capture-recapture model. , 2014, Drug and alcohol dependence.

[22]  I. Demaret,et al.  Staff concerns in heroin-assisted treatment centres. , 2012, Journal of psychiatric and mental health nursing.

[23]  N. Bansback,et al.  Cost-effectiveness of diacetylmorphine versus methadone for chronic opioid dependence refractory to treatment , 2012, Canadian Medical Association Journal.

[24]  M. Ferri,et al.  Heroin maintenance for chronic heroin-dependent individuals. , 2011, The Cochrane database of systematic reviews.

[25]  K. Mills,et al.  The impact of post-traumatic stress disorder on treatment outcomes for heroin dependence. , 2007, Addiction.

[26]  E. Perea-Millá,et al.  Controlled trial of prescribed heroin in the treatment of opioid addiction. , 2006, Journal of substance abuse treatment.

[27]  R. Groves,et al.  The Role of Topic Interest in Survey Participation Decisions , 2004 .

[28]  T. Perneger,et al.  Randomised trial of heroin maintenance programme for addicts who fail in conventional drug treatments , 1998, BMJ.

[29]  J. Strang,et al.  Heroin prescribing in the "British System" of the mid 1990s: data from the 1995 national survey of community pharmacies in England and Wales. , 1997, Drug and alcohol review.

[30]  Allison J. Ober,et al.  Acceptability of Heroin-Assisted Treatment and Supervised Drug Consumption Sites to Address the Opioid Crisis in the United States: Key Informant Perspectives , 2018 .

[31]  Feng Chang,et al.  Perceived Barriers and Facilitators to Providing Methadone Maintenance Treatment Among Rural Community Pharmacists in Southwestern Ontario , 2018, The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association.

[32]  L. Simpson.  The Obstacles to Implementing Supervised Injection Services in Ottawa, Ontario , 2017 .

[33]  C. Banta-Green,et al.  Health behaviors of young adult heroin injectors in the Seattle area. , 2016, Drug and alcohol dependence.

[34]  Pierre Paillé,et al.  L'analyse qualitative en sciences humaines et sociales , 2012 .

[35]  S. Brochu,et al.  A heroin prescription trial: case studies from Montreal and Vancouver on crime and disorder in the surrounding neighbourhoods. , 2010, The International journal on drug policy.

[36]  J. March,et al.  Nursing in an Intravenous Heroin Prescription Treatment , 2007 .

[37]  T. Valente,et al.  Implementing evidence-based practices for treatment of alcohol and drug disorders. , 2006 .

[38]  J. Strang,et al.  Heroin Prescribing in the British System: Historical Review , 1996 .