Table 4:

Frequency with which barriers and facilitators of injectable opioid agonist programs for ongoing service delivery were reported

BarriersNo. (%) of programsFacilitatorsNo. (%) of programs
Limited program capacity7 (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 restrictions5 (36)Low-barrier access (e.g., service in supported housing)6 (43)
Inadequate staff coverage or capacity4 (29)Harm reduction approach5 (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 flow5 (36)
Inadequate ancillary services and facilities (e.g., lack of community housing and counselling support)4 (29)Active client follow-up to support engagement4 (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 hours3 (21)Well-trained and knowledgeable nursing staff2 (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 OAT1
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 team1
Lack of programming for specific groups: females, youth, Indigenous people (e.g., female-only sessions)1Onsite provision of all medications prescribed to client1
Lack of access to brand-name medications (i.e., access to generic hydromorphone only)1Establishment of a provincial reference number for hydromorphone dispensing within electronic system1
  • 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.