Barriers and facilitators to a novel low-barrier hydromorphone distribution program in Vancouver, Canada: a qualitative study
Barriers and facilitators to a novel low-barrier hydromorphone distribution program in Vancouver, Canada: a qualitative study
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DOI：
10.1016/j.drugalcdep.2020.108202
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发表时间：
2020-11-01
影响因子：
4.2
通讯作者：
McNeil, Ryan
中科院分区：
文献类型：
--
作者：
Ivsins, Andrew;Boyd, Jade;McNeil, Ryan
背景：由于非法生产的芬太尼、相关类似物和掺杂芬太尼的药物，北美正在经历一场过量用药危机。有人建议将“安全供应”的概念作为一项潜在措施，通过向致命过量风险较高的人提供非法阿片类药物的受监管替代品来解决过量危机。2019年1月，在加拿大市中心东区温哥华的一个过量预防地点实施了一项新的氢吗啡片分发计划。本研究探讨参与此计画的障碍与促进者。方法：对42名参与氢化吗啡片发放计画的参与者进行深入访谈，并在研究现场及周边进行超过100小时的人种学观察。访谈和人种学观察的主题分析侧重于计划操作，包括计划摄取、获取和参与的障碍和促进者。结果：确定的计划参与障碍包括：有限的操作时间和给药时间表，在过量用药预防地点内的同一地点(例如，等待时间)，以及接受氢吗啡酮的仿制制剂。被确定的促进者包括：能够获得可靠的阿片类药物来源，在过量药物预防地点内共处一地(例如，低障碍设计)，机构的经验，以及计划的灵活性。结论：我们的研究结果证明了安全供应计划的关键实施和操作考虑。特别是，应考虑较低门槛的设计和操作特点，以提高吸收和参与度。安全阿片类药物供应计划是一种有希望的干预措施，通过为致命过量的高风险人群提供有毒药物供应的替代方案，解决北美持续的过量危机。
Background: North America is experiencing an overdose crisis driven by illicitly-manufactured fentanyl, related analogues, and fentanyl-adulterated drugs. The concept of 'safe supply' has been suggested as a potential measure to address the overdose crisis by providing a regulated alternative to illicit opioids to people at high risk of fatal overdose. In January 2019, a novel hydromorphone tablet distribution program was implemented within an overdose prevention site in Vancouver, Canada's Downtown Eastside neighbourhood. This study explored barriers and facilitators to engagement with this program.Methods: In-depth interviews were conducted with 42 participants enrolled in the hydromorphone tablet distribution program, and over 100 h of ethnographic observation were conducted in and around the study site. Thematic analysis of the interviews and ethnographic observation focused on program operation, including barriers and facilitators to program uptake, access, and engagement.Results: Barriers to program engagement identified include: limited operating hours and dose schedule, co-location within the overdose prevention site (e.g., wait times), and receiving the generic formulation of hydromorphone. Facilitators identified include: having access to a reliable source of opioids, co-location within the overdose prevention site (e.g., low-barrier design), experiences of agency, and program flexibility.Conclusion: Our findings demonstrate key implementation and operational considerations of safe supply programs. In particular, lower-barrier design and operational features should be considered to improve uptake and engagement. Safe opioid supply programs are a promising intervention to address North America's ongoing overdose crisis by providing people at high risk of fatal overdose an alternative to the toxic drug supply.