Outcomes of Ottawa, Canada's Managed Opioid Program (MOP) where supervised injectable hydromorphone was paired with assisted housing

Harris, Miriam; Seliga, Rebecca K; Fairbairn, Nadia; Nolan, Seonaid; Walley, Alexander Y.; Weinstein, Zoe; Turnbull, Jeffery

doi:10.1016/j.drugpo.2021.103400

Cited by 14 publications

(7 citation statements)

References 21 publications

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“…Qualitative studies have evaluated the benefits of witnessed hydromorphone tablet consumption, which is more flexible and less resource-intensive than witnessed iOAT ( Ivsins et al, 2021 , Ivsins et al, 2020 ). A recent study from Ottawa, Canada, describes positive outcomes for people with severe opioid use disorder who are provided hydromorphone iOAT along with supported housing ( Harris et al, 2021 ). Benefits of managed alcohol programs are also clearly established for people with severe alcohol use disorder, and particularly people who drink non-beverage alcohol ( Stockwell et al, 2021 , Stockwell et al, 2018 , Crabtree et al, 2018 ).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of an emergency safe supply drugs and managed alcohol program in COVID-19 isolation hotel shelters for people experiencing homelessness

Brothers

Leaman²,

Bonn³

et al. 2022

Drug and Alcohol Dependence

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Section: Discussionmentioning

confidence: 99%

Evaluation of an emergency safe supply drugs and managed alcohol program in COVID-19 isolation hotel shelters for people experiencing homelessness

Brothers

Leaman²,

Bonn³

et al. 2022

Drug and Alcohol Dependence

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“…One study found participants in a prescribed safer supply programme in London, Canada, were less likely to be hospitalized with injecting-related bacterial infections compared to before they entered the programme [108]. Social and supportive housing (including Housing First) can help people who use drugs access and maintain housing; some models combine housing with injectable OAT, safe supply and/or supervised consumption sites [109][110][111]. In some jurisdictions, people who use drugs and their allies have successfully advocated for decriminalization of drug and/or syringe possession and for laws enabling supervised consumption sites [112].…”

Section: Discussionmentioning

confidence: 99%

Social and structural determinants of injection drug use‐associated bacterial and fungal infections: A qualitative systematic review and thematic synthesis

Brothers

Bonn²,

Lewer

et al. 2023

Addiction

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Background and aimsInjection drug use‐associated bacterial and fungal infections are increasingly common, and social contexts shape individuals’ injecting practices and treatment experiences. We sought to synthesize qualitative studies of social–structural factors influencing incidence and treatment of injecting‐related infections.MethodsWe searched PubMed, EMBASE, Scopus, CINAHL and PsycINFO from 1 January 2000 to 18 February 2021. Informed by Rhodes’ ‘risk environment’ framework, we performed thematic synthesis in three stages: (1) line‐by‐line coding; (2) organizing codes into descriptive themes, reflecting interpretations of study authors; and (3) consolidating descriptive themes into conceptual categories to identify higher‐order analytical themes.ResultsWe screened 4841 abstracts and included 26 qualitative studies on experiences of injecting‐related bacterial and fungal infections. We identified six descriptive themes organized into two analytical themes. The first analytical theme, social production of risk, considered macro‐environmental influences. Four descriptive themes highlighted pathways through which this occurs: (1) unregulated drug supply, leading to poor drug quality and solubility; (2) unsafe spaces, influenced by policing practices and insecure housing; (3) health‐care policies and practices, leading to negative experiences that discourage access to care; and (4) restrictions on harm reduction programmes, including structural barriers to effective service provision. The second analytical theme, practices of care among people who use drugs, addressed protective strategies that people employ within infection risk environments. Associated descriptive themes were: (5) mutual care, including assisted‐injecting and sharing sterile equipment; and (6) self‐care, including vein health and self‐treatment. Within constraining risk environments, some protective strategies for bacterial infections precipitated other health risks (e.g. HIV transmission).ConclusionsInjecting‐related bacterial and fungal infections are shaped by modifiable social–structural factors, including poor quality unregulated drugs, criminalization and policing enforcement, insufficient housing, limited harm reduction services and harmful health‐care practices. People who inject drugs navigate these barriers while attempting to protect themselves and their community.

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“…Given the known associations between sociostructural factors and overdose risk, 32 – 35 our findings underscore the importance of addressing issues attendant to drug use and overdose vulnerability, and are in line with previous research showing the feasibility of safer supply programs to address matters at the intersection of drug use, drug market volatility and social determinants of health. 3 , 13 , 15 , 36 …”

Section: Discussionmentioning

confidence: 99%

Safer opioid supply via a biometric dispensing machine: a qualitative study of barriers, facilitators and associated outcomes

Bardwell

Ivsins

Mansoor

et al. 2023

CMAJ

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Background: The MySafe program provides pharmaceutical-grade opioids to participants with opioid use disorder via a biometric dispensing machine. The objectives of this study were to examine facilitators and barriers to safer supply via the MySafe program and the associated outcomes. Methods: We conducted semistructured interviews with participants who had been enrolled in the MySafe program for at least a month at 1 of 3 sites in Vancouver. We developed the interview guide in consultation with a community advisory board. Interviews focused on context of substance use and overdose risk, enrolment motivations, program access and functionality, and outcomes. We integrated case study and grounded theory methodologies, and used both conventional and directed content analyses to guide inductive and deductive coding processes. Results: We interviewed 46 participants. Characteristics that facilitated use of the program included accessibility and choice, a lack of consequences for missing doses, nonwitnessed dosing, judgment-free services and an ability to accumulate doses. Barriers included technological issues with the dispensing machine, dosing challenges and prescriptions being tied to individual machines. Participant-reported outcomes included reduced use of illicit drugs, decreased overdose risk, positive financial impacts and improvements in health and well-being. Interpretation: Participants perceived that the MySafe program reduced drug-related harms and promoted positive outcomes. This service delivery model may be able to circumvent barriers that exist at other safer opioid supply programs and may enable access to safer supply in settings where programs may otherwise be limited.

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Outcomes of Ottawa, Canada's Managed Opioid Program (MOP) where supervised injectable hydromorphone was paired with assisted housing

Cited by 14 publications

References 21 publications

Evaluation of an emergency safe supply drugs and managed alcohol program in COVID-19 isolation hotel shelters for people experiencing homelessness

Evaluation of an emergency safe supply drugs and managed alcohol program in COVID-19 isolation hotel shelters for people experiencing homelessness

Social and structural determinants of injection drug use‐associated bacterial and fungal infections: A qualitative systematic review and thematic synthesis

Safer opioid supply via a biometric dispensing machine: a qualitative study of barriers, facilitators and associated outcomes

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