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

Abstract

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.

Three noteworthy idiosyncrasies related to Canada's opioid‐death crisis, and implications for public health‐oriented interventions

“…This objective appears to centrally require increased, while evidence-based, precautious and locally adapted mobilisation and utilisation of 'safer drug supply' distribution measures with the aim to replace potent/toxic drug supply with PWUD's use of 'safer' pharmaceutical-grade substances for emergencybased health protection [1,19]. While data are only emerging and limited to date, assessments of different modalities of 'safer opioid supply' initiatives implemented through local programmes in different settings across Canada have suggested substantive improvements in overdose risk and experiences and related health harm and/or emergency department visits/hospitalisations among participants, and so support increased mobilisation [20][21][22]. On this basis, best practice models for safer supply programming have yet to be formalised and tailoring to local drug use and risk ecologies (e.g., depending on substance preferences) are required; yet, they appear to offer the opportunity to directly reduce tangible overdose-related risks and harm with PWUD at high risk.…”