Background/Objectives
In 2020, amidst declared dual public health emergencies (COVID 19 and toxic drug deaths), BC introduced Risk Mitigation Guidance (RMG), the first provincial safer supply initiative allowing prescribing of some categories of opioids and stimulants. We identified factors influencing access and continuity of prescriptions from the perspectives of those accessing RMG medications.
Methods:
We undertook a mixed methods study within a broader framework of community based participatory research involving people who use drugs, and informed by the Consolidated Framework for Implementation Research. Baseline and longitudinal surveys (n = 353) were conducted over the phone or in person. A subset of survey participants (n=54) completed a qualitative interview. Convergent analysis was conducted of survey and interview data to identify factors influencing access and continuity.
Results:
Within an ongoing context of criminalization of drug use, 22% of participants, who had an encounter with police, reported confiscation of prescriptions. The organizational delivery of RMG varied widely across the province creating uneven implementation and a range of diverse experiences within different settings. Experiences with pharmacies were identified as a key factor influencing the implementation process and continuity. The intervention was effective for managing withdrawal in less than half of participants, highlighting issues with medication dosages, types, and routes of administration.
Implications
These findings highlight wide variation in RMG implementation and the impacts of prohibition on implementation. Program level factors such as organizational culture in clinics and pharmacies as well as individual tailoring of the intervention are important to maintenance of a prescription.