Theme: Models of Care Year: 2019
Background: Canada is facing a major opioid overdose crisis and rapid access to opioid agonist
treatment (OAT) constitutes one of the answers to this crisis. Unfortunately, many barriers still
continue to prevent access and retention in OAT. Our research reviewed the literature in order to
identify models of care meeting the needs of difficult to reach populations. Seven low-threshold OAT
initiatives (including interviews with 37 persons who use opioids) were interviewed in Québec to
identify what are the philosophy of intervention, the services and the organization of care needed to
reach the most vulnerable opioid users.
Description of model of care/intervention: The narrative review of the literature highlights key
concepts in the philosophy of intervention. They include working in a harm reduction/low-threshold
perspective, patient centered care, capacity to outreach and the ability to engage in a trusty
relationship. The models of care identified are those who offer comprehensive and integrated care
including primary care, specialized services (HCV, HIV and mental health) and social services within
OAT programs. The organization of care includes multidisciplinary teams, implication of peers and
the capacity to adapt to individual needs.
Our interviews in Québec OAT programs revealed that stigma continues to undermine access to
health care for people who use drugs (PWUD). PWUD are asking for shared decision making
regarding their OAT and possibility of having goals other than abstinence. HCV treatment and peers
are not yet included in most OAT programs. Teams are asking for support and more collaboration
with community-based organization and street workers.
Conclusion and next steps: The literature identifies key principles that should guide care
organization around OAT in order to reach the most vulnerable opioid users. Québec will need to
develop more low-threshold OAT programs that will offer integrated services relying of
multidisciplinary teams and on peers.
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considerable contribution that industry partners make to professional and research activities. We
also recognise the need for transparency of disclosure of potential conflicts of interest by
acknowledging these relationships in publications and presentations.