Exploring the experiences of staff working at an opiate assisted treatment clinic: An interpretive descriptive study

Abstract

There have been many advances in harm reduction over the past three decades. One of the newest approaches is the provision of medical grade heroin to people with opiate addiction, known as opiate assisted treatment (OAT). There is one clinic in North America which provides this service. The goal of this study was to uncover how clinic staff provide care to those who attend this clinic, their perspectives on how the clinic program impacted them and their patients, and their opinions about the program itself. This was a qualitative study with an interpretive descriptive methodology underpinned by critical social theory. Convenience sampling yielded 22 participants – 18 nurses, two social workers and two peer support workers. Thematic analysis was undertaken to identify recurring, converging and contradictory patterns of interaction, key concepts and emerging themes. The study location was the OAT clinic located in the downtown eastside of Vancouver, BC. The findings were organized around the following six themes: from chaos to stability, it's not all roses, a little preparation would be good, putting the patient at the centre, the stigma hasn't gone away, and the clinic is life transforming. Taken together, these themes indicate the complexities of working in this environment. The findings can guide clinic staff, including nurses, in how they provide care to patients with addiction problems and also provide direction for policy makers on harm reduction planning. Contribution of the paperWhat is already known about the topic?•Opiate Assisted Treatment is an effective harm reduction approach to care and there is only one clinic offering this treatment approach in North America.•There is limited research on opiate assisted treatment clinics; research is primarily conducted in Europe.•Staff working in clinics that provide opiate assisted treatment are primarily concerned about overdoses and the diversion of heroin.What does this paper add?•Staff working in clinics that offer opiate assisted treatment engage in complex and challenging care, which is also very rewarding.•Patient outcomes in opiate assisted treatment clinics are positively impacted by the approach of staff.•This novel work establishes the importance of attending to the effects of educational preparation, power dynamics, and physical space on staff working at opiate assisted treatment clinics, for developing successful harm reduction programs.