Frequency with which barriers and facilitators of injectable opioid agonist programs for ongoing service delivery were reported
| Barriers | No. (%) of programs | Facilitators | No. (%) of programs |
|---|---|---|---|
| Limited program capacity | 7 (50) | Client-centred care (e.g., responsive to client goals and needs) | 13 (93) |
| Pharmacy operations (e.g., dispensing delays, inadequate missed dose or dose adjustment protocols, lack of community pharmacy partner options for maintenance doses or syringe preparation) | 6 (43) | Relationships with clients (e.g., rapport, trust, sense of community, client involvement in care plan) | 10 (71) |
| Lack of diacetylmorphine access (i.e., medical heroin) | 5 (36) | Access to ancillary services (e.g., other health and social services to provide wraparound care) | 7 (50) |
| Strength of available medication too low (e.g., only 10 mg/mL in Ontario) | 5 (36) | Strong relationship with community partners (e.g., overdose outreach team, other health services such as primary care, community iOAT service providers) | 7 (50) |
| Physical space restrictions | 5 (36) | Low-barrier access (e.g., service in supported housing) | 6 (43) |
| Inadequate staff coverage or capacity | 4 (29) | Harm reduction approach | 5 (36) |
| Issues associated with oral OAT provision (e.g., none onsite, lack of access to preferred medication) | 4 (29) | Rapid and simple process for new starts (e.g., same day) | 5 (36) |
| Issues associated with management of stimulant use (e.g., ongoing concurrent use, presence of fentanyl and carfentanil in stimulants) | 4 (29) | Peer workers to support engagement and clinical flow | 5 (36) |
| Inadequate ancillary services and facilities (e.g., lack of community housing and counselling support) | 4 (29) | Active client follow-up to support engagement | 4 (29) |
| Challenges with continuity of care (e.g., from community to jail, prison or acute care; from acute care to community) | 4 (29) | Pharmacy relationship (e.g., onsite pharmacy, strong partnership with community pharmacy dispensing iOAT) | 4 (29) |
| Treatment induction issues (e.g., lag time between eligibility approval and first dose, inadequate titration protocols, prolonged wait times for split doses) | 3 (21) | Housing First approach (e.g., shelter into housing) | 2 (14) |
| Limited opening hours | 3 (21) | Well-trained and knowledgeable nursing staff | 2 (14) |
| Issues associated with group allocation as dose access structure (e.g., access barrier for clients, management challenges for staff) | 3 (21) | Multiple physician prescribers to provide adequate cover for assessments, dose adjustments and oral OAT | 1 |
| Inadequate client records or tracking (e.g., paper-based records, lack of monitoring and active follow-up to support engagement) | 2 (14) | Access to diacetylmorphine (i.e., medical heroin) | 1 |
| Challenges associated with engaging clients (e.g., clinical adherence, following rules and responsibilities of service) | 2 (14) | Regular communication within a multidisciplinary team | 1 |
| Lack of programming for specific groups: females, youth, Indigenous people (e.g., female-only sessions) | 1 | Onsite provision of all medications prescribed to client | 1 |
| Lack of access to brand-name medications (i.e., access to generic hydromorphone only) | 1 | Establishment of a provincial reference number for hydromorphone dispensing within electronic system | 1 |
Note: Barriers and facilitators are reported only once when: a) reported in baseline and follow-up; b) barriers/facilitators fall within the same theme for the same program.
Participants reported barriers and facilitators in response to open-ended questions. iOAT = injectable opioid agonist treatment, OAT = opioid agonist treatment.