"You'll come in and dose even in a global pandemic": A qualitative study of adaptive opioid agonist treatment provision during the COVID-19 pandemic

Anna Conway; Carla Treloar; Sione Crawford; Louisa Degenhardt; Gregory J Dore; Michael Farrell; Jeremy Hayllar; Jason Grebely; Alison D Marshall

doi:10.1016/j.drugpo.2023.103998

"You'll come in and dose even in a global pandemic": A qualitative study of adaptive opioid agonist treatment provision during the COVID-19 pandemic

Int J Drug Policy. 2023 Apr:114:103998. doi: 10.1016/j.drugpo.2023.103998. Epub 2023 Mar 6.

Authors

Anna Conway¹, Carla Treloar², Sione Crawford³, Louisa Degenhardt⁴, Gregory J Dore⁵, Michael Farrell⁴, Jeremy Hayllar⁶, Jason Grebely⁵, Alison D Marshall⁷

Affiliations

¹ The Kirby Institute, UNSW, Sydney, Australia; Centre for Social Research in Health, UNSW, Sydney, Australia. Electronic address: a.conway@unsw.edu.au.
² Centre for Social Research in Health, UNSW, Sydney, Australia.
³ Harm Reduction Victoria, Melbourne, Australia.
⁴ National Drug and Alcohol Research Centre, UNSW, Sydney, Australia.
⁵ The Kirby Institute, UNSW, Sydney, Australia.
⁶ Alcohol and Drug Service, Metro North Mental Health, Metro North Hospital and Health Service, Brisbane, Queensland, Australia.
⁷ The Kirby Institute, UNSW, Sydney, Australia; Centre for Social Research in Health, UNSW, Sydney, Australia.

Abstract

Background: Opioid agonist treatment (OAT) improves multiple health and social outcomes, yet requirements to attend for supervised dosing can be burdensome and stigmatising. The COVID-19 pandemic and associated restrictions threatened continuity of care and the wellbeing of people receiving OAT, risking a parallel health crisis. This study sought to understand how adaptations in the complex system of OAT provision impacted and responded to risk environments of people receiving OAT during the COVID-19 pandemic.

Methods: The analysis draws on semi-structured interviews with 40 people receiving and 29 people providing OAT located across Australia. The study considered the risk environments that produce COVID-19 transmission, treatment (non-)adherence, and adverse events for people receiving OAT. Drawing on theories of risk environments and complex adaptive systems, data were coded and analysed to understand how adaptations to the typically rigid system of OAT provision impacted and responded to risk environments during the COVID-19 pandemic.

Results: During COVID-19, the complex system of OAT provision demonstrated possibilities for responsive adaptation to the entangled features of risk environments of people receiving OAT. Structural stigma was evident in the services which stayed rigid during the pandemic, requiring people to attend for daily supervised dosing and risking fracturing therapeutic relationships. In parallel, there were several examples of services developing enabling environments by offering flexible care through increased takeaways, treatment subsidies, and home delivery.

Conclusions: Rigidity in the delivery of OAT has been an impediment to achieving health and wellbeing over past decades. To sustain health-promoting environments for people receiving OAT, the wider impacts of the complex system should be acknowledged beyond narrowly defined outcomes relating solely to the medication. Centring people receiving OAT in their own care plans will ensure adaptations in the complex system of OAT provision are responsive to the individual's risk environment.

Keywords: Drug users; Injecting; PWID; Risk environment; SARS-CoV-2; Treatment.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Analgesics, Opioid / therapeutic use
COVID-19*
Humans
Opiate Substitution Treatment
Opioid-Related Disorders* / epidemiology
Pandemics

Substances

Analgesics, Opioid