Barriers and facilitators to opioid agonist therapy in rural and remote communities in Canada: an integrative review

Abstract

Background People living in rural and remote communities in Canada are often disproportionately impacted by opioid use disorder. When compared to urban centres, rural and remote populations face additional barriers to treatment, including geographical distance as well as chronic shortages of health care professionals. This integrative review of the literature was conducted to explore the facilitators and barriers of OAT in rural and remote Canadian communities. Methods A search of the literature identified relevant studies published between 2001 and 2021. Results The search strategy yielded 26 scholarly peer-reviewed publications, which explored specific barriers and facilitators to rural and remote OAT in Canada, along with two reports and one fact sheet from the grey literature. Most of the scholarly articles were descriptive studies (n = 14) or commentaries (n = 9); there were only three intervention studies. Facilitators and barriers to OAT programs were organized into six themes: intrapersonal/patient factors, social/non-medical program factors, family/social context factors (including community factors), infrastructure/environmental factors, health care provider factors, and system/policy factors. Conclusions Although themes in the literature resembled the social-ecological framework, most of the studies focused on the patient-provider dyad. Two of the most compelling studies focused on community factors that positively impacted OAT success and highlighted a holistic approach to care, nested in a community-based holistic model. Further research is required to foster OAT programs in rural and remote communities.

Wastewater-based surveillance identifies start to the pediatric respiratory syncytial virus season in two cities in Ontario, Canada

“…In regions without an existing wastewater surveillance system, establishing sample collection and transportation logistics can pose challenges and significant initial planning and capital costs. Onboarding of remote communities presents even greater challenges due to constraints such as limited numbers of trained professionals, a notable barrier to implementation in these environments ( 35 , 36 ). However, existing wastewater surveillance sites could serve as sentinel nodes for RSV WBS, with priority given to sites with geographic representativeness (e.g., urban and rural areas across the province).…”

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

“…Our findings suggest that the MySafe model could be beneficial in other settings, particularly in jurisdictions with challenges in accessing safer supply, including rural and remote communities with geographical and transportation barriers and in pharmacies that are under-resourced and have limited hours of operation. 53 , 54 In addition, this model shows promise for medication delivery beyond safer supply and could include opioid agonist therapy, direct-acting antiviral tablets or other medications that are commonly accessed by marginalized groups. This would be especially beneficial for structurally vulnerable populations who have compounding barriers when accessing services related to substance use (e.g., Indigenous and racialized communities, sex workers, gender and sexual minorities).…”

Methadone Prescribing Regulation for Opioid Use Disorder in Canada: Evidence for an East–West Policy Divide

“…It is an effective, safe and widely used treatment for opioid use disorder (OUD), or opioid addiction, that involves treatment with long-acting opioid medications such as methadone, buprenorphine or slow-release oral morphine in order to manage withdrawal and cravings ( Neale et al 2019 ). As in many other jurisdictions internationally, despite its effectiveness and the important initiatives undertaken to expand access, Canadians continue to have limited access to OAT due to a number of intersecting structural forces, such as stigma related to drug use, insufficient training of prescribers and stringent regulation of prescribing ( Pijl et al 2022 ).…”

“…Opioid agonists are considered controlled substances and, until recently, providers were required to obtain a Canadian federal Section 56 Exemption from the Controlled Drugs and Substances Act (1996) in order to prescribe, sell, provide or administer methadone ( CRISM 2017 ). In addition to having to comply with this federal regulation, health professionals must also comply with the distinct provincial/territorial prescribing and dispensing regulations for education, training and monitoring under the oversight of the provincial/territorial medical, nursing and pharmacy regulatory colleges ( CRISM 2017 ; Pijl et al 2022 ). These provincial/territorial regulations have, to a great extent, been influenced by federal exemption requirements.…”