Accessible Care: The Human Rights Case for Take-Home Injectable Opioid Agonist Treatment

Abstract

Substance use disorders comprise a significant portion of disability experiences in Canada and are often experienced alongside other disabilities. During the pandemic, there were declines in healthcare and substance use treatment utilization. In response, new risk mitigation guidelines aimed to increase substance use treatment accessibility, advancing the right to available, accessible, acceptable, and quality healthcare. Injectable opioid agonist treatment (iOAT), a highly regimented treatment with daily supervised doses, became available in take-home doses for a select group of clients. We conducted qualitative interviews with iOAT clients to understand intersections of disability and accessibility with traditional and take-home iOAT. Twenty-three clients accessing either traditional iOAT, take-home iOAT, or delivery through COVID-19 mitigation guidelines were interviewed (2021-2022). Data were analyzed through a critical realist lens, using an abductive coding approach. Clients described traditional iOAT as, at times, inaccessible. Clients encountered barriers in neighbourhoods (e.g., sidewalk obstructions) and within social housing units (e.g., broken elevators), as well as through physical symptoms (e.g., chronic pain) and mental health concerns. Clinic attendance was impeded by drug- and treatment- related stigma and fear of discrimination (e.g., by employers, in social relationships). Conversely, take-home iOAT increased accessibility, offering clients a sense of freedom, dignity, autonomy, and free time, and thus greater emotional and social fulfillment. Take-home iOAT is a more accessible treatment approach that addresses the fluctuating needs of clients, especially those with additional disabilities. Expanding access to take-home iOAT aligns with human rights-based healthcare and uplifts economic, social, and cultural rights of people who need this care.