How injectable opioid agonist treatment (iOAT) care could be improved? service providers and stakeholders’ perspectives

Abstract

Background Addressing inadequacies in the implementation of existing evidence-based approaches into practice, such as injectable opioid agonist treatment (iOAT), is imperative for the management of opioid use disorder. With the expansion of iOAT, stakeholder perspectives are needed to inform program optimization. This study aimed to understand stakeholder and provider perspectives on iOAT care and how it can be improved to better meet service users’ needs. Methods Semi-structured interviews (n = 11), email correspondence (n = 2), a focus group (n = 4), and one regional meeting were conducted with iOAT stakeholders to receive feedback on how iOAT can better meet service users’ needs. Qualitative analysis employed a thematic and interpretive description approach to identify key themes, presented as a thematic summary. Results Stakeholder narratives highlight the importance they attribute to client autonomy, individualized care, tensions between providers and the system (policies, governing structures, etc., that establish, facilitate and determine how iOAT is delivered in Canada) as well as power dynamics between providers and service users. Conclusion IOAT providers and stakeholders surveyed in this study are committed to seeing the needs of service users met but often feel constrained by system-level regulations that influence power dynamics between providers and service users. Findings underline pragmatic suggestions to advance person-centered care as a way to make iOAT accessible and individualized.