ArticleHarm reduction journal2024
Challenges for the implementation of injectable opioid agonist treatment: a scoping review.
Article in Harm reduction journal, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
1 citing paper in PubMed, 1 synthesis or guideline pooled it.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
BACKGROUND AND
aimsInjectable opioid agonist treatment (iOAT) is a valuable, patient-centred, evidence based intervention. However, limited information exists on contextual factors that may support or hinder iOAT implementation and sustainability. This study aims to examine existing research on iOAT using diacetylmorphine and hydromorphone, focusing on identifying the key barriers and facilitators to its successful implementation.
methodsA systematic search was conducted in the MEDLINE and PsycInfo databases (via Ovid) from inception to February 2024, supplemented by a comprehensive grey literature search. No restrictions were applied regarding publication type, year, or geographic location. Articles were independently screened by two reviewers. Eligible articles described the feasibility, implementation, and/or evaluation of iOAT in one or more countries, presenting perspectives on receiving, administering, or governing iOAT.
resultsForty-four publications were selected for inclusion. Barriers identified through thematic analysis included public acceptance concerns such as medication diversion, increased crime, and the Honey-Pot effect. Legal and ethical challenges identified involved enacting changes in law to make certain substances available as a medically controlled options for treatment, and addressing patient consent issues. Negative media coverage and public controversies were found to undermine acceptance, and high start-up costs especially for security, facility access, and economic feasibility were seen as additional obstacles. Regulatory barriers and stringent protocols were the most frequently cited limiting factors by patients and providers. Facilitators included the integration of trial prescriptions into comprehensive drug policy strategies and publishing data for evidence-based debates, together with ethics committees ensuring compliance with ethical standards. Developing information strategies and addressing opponents' claims improved public perception. Cost-effectiveness evidence was found to support long-term implementation, while flexible treatment protocols, inclusive spaces, and affirming therapeutic relationships were seen as important facilitators to enhance patient engagement and treatment effectiveness.
conclusionsSuccessful implementation of iOAT requires balancing political and social acceptability with scientific integrity, alongside strategic communication and public outreach. Further research is needed to enhance the transferability of findings across diverse socio-political contexts and address key influencing factors associated with iOAT programs.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.