Table 3 Experiences of barriers to safer supply prescribing
Barriers endorsed in the survey (n = 338) | Exemplar quotes from interviews (n = 54) 1 | |||
|---|---|---|---|---|
Outer context | % | SMD | Theme: Substance use stigma and criminalization Who wants to go see somebody every day to be looked down on? (2486, had a prescription, large urban centre) I wouldn’t go to a doctor like asking for this stuff because I would feel like they’d almost… just kind of like “Oh yeah, no, just, just another addict trying to get drugs,” right? … kind of more that mentality… I find that, that that’s a lot out here. (2865, no prescription, medium/smaller centre/rural area) I just think it’s lack of knowledge and … stigma… A lot of people that I talk to, they’re like “Don’t even go to the hospital. Like it’s not even worth it” I’ve heard from some people it’s gotten better, I’ve heard from some people it’s gotten worse. But from my experience, it’s not that great there. (2865, no prescription, medium/smaller centre/rural area) [In region] they’re terrible…They were very judgmental and it’s really, really hard to deal with them… Everybody thinks they’re better than everyone, right? Well, here it’s just as true too but, more like if you go to the hospital they treat you like shit. If you go to a substance abuse clinic, they’re okay but [in region] since it’s a small town…they all just talk shit… (2361, no prescription, large urban centre) I won’t fault them for little things because they’re already just doing amazing because …. they’re not huge assholes. That’s how low the bar has been set. (3039, had a prescription, large urban centre) | |
Fear of, or past experiences of, stigma in health care | Had a prescription | 60.2% | 0.278 | |
No prescription | 73.2% | |||
Large urban centre | 63.8% | 0.044 | ||
Medium/small centre/rural area | 61.6% | |||
COVID-19 | Had a prescription | 37.1% | 0.286 | |
No prescription | 51.2% | |||
Large urban centre | 39.6% | 0.085 | ||
Medium/small centre/rural area | 43.8% | |||
Safety concerns | Had a prescription | 34.0% | 0.278 | |
No prescription | 47.6% | |||
Large urban centre | 36.2% | 0.100 | ||
Medium/small centre/rural area | 41.1% | |||
Fear children would be taken | Had a prescription | 4.7% | 0.235 | |
No prescription | 11.0% | |||
Large urban centre | 6.0% | 0.033 | ||
Medium/small centre/rural area | 6.9% | |||
Inner context | % | SMD | Theme: It’s hard to get [The doctors] live about 116 km away… there isn’t someone who’s just there all the time, or like 9 to 5, Monday through Friday… make it easily more accessible. Not have to wait a week to see somebody… I’ve heard there’s like a 400-person waiting list right now. [Laughs] (2446, had a prescription, medium/smaller centre/rural area) Why do we assume that people with addictions are going to be able to access clinics that are open from 1 to 3 each day or whatever in rural communities. A lot of people who use drugs have jobs… if we’re really going to help people with their healthcare, it needs to be available when and where they need it. (3636, had a prescription, medium/smaller centre/rural area). There’s a couple [of prescribers]. They do most of it through video phone conference at a clinic… you don’t see doctors face to face much just because it’s a smaller town, there’s not many people prescribing that here… (3720, had a prescription, medium/smaller centre/rural area) It’s only OAT providers providing this sort of care. So if it was able to be done – and it is able to be done by GPs as far as I understand – if we could get more of them on board, this would be amazing for people who want to maintain a level of privacy… (3552, had a prescription, large urban centre) They can be very judge-y. And, you know, judgmental. And I think that’s maybe a reason why not very many people might be going for this is because… You don’t want to feel like you’re being judged, right? People up there…you’re just an addict. You’re an addict, you’re a junkie, or this. …but I’m trying to get help, right? (2853, no prescription, medium/smaller centre/rural area) | |
Poor service accessibility | Had a prescription | 51.8% | 0.388 | |
No prescription | 69.5% | |||
Large urban centre | 55.5% | 0.014 | ||
Medium/small centre/rural area | 54.8% | |||
Lack of privacy | Had a prescription | 24.6% | 0.105 | |
No prescription | 29.3% | |||
Large urban centre | 25.7% | 0.008 | ||
Medium/small centre/rural area | 26.0% | |||
Implementation process | % | SMD | Theme: No information, few prescribers A couple of [friends] have said like “Yeah, I went in there. I was like ‘What about the Dilaudid thing?’ And they were like ‘Yeah, no. That won’t work for you.’” [Laughs]…Okay, anyways. Carry on. Yeah. “It’s not for you.” (2890, no prescription, setting missing) Participant: I spoke to my doctor about it. And then um, I was told by [clinic] that if I already had a methadone doctor I was not allowed to switch doctors to get a doctor that would prescribe it to me… So I was stuck. I couldn’t get it. Interviewer: what happened when you asked your doctor? Participant: Um, she said point blank: “No.” She doesn’t give it. She doesn’t believe in it. (2524, no prescription, medium/smaller centre/rural area) I honestly thought it was just like a Vancouver thing… because if I had of known that it was all of BC…I think I would… have tried to… go to a normal doctor and ask (2865, no prescription, medium/smaller centre/rural area) We have a shortage of doctors… One in four [people in BC] are unconnected to a [GP], and the rest are walk-in clinics, which as we know, are not able to prescribe opiate-based, or narcotic-based, drugs… So we are quite limited in what we have. (3552, no prescription, large urban centre). | |
Negative reaction from a health care provider | Had a prescription | 29.3% | 0.305 | |
No prescription | 43.9% | |||
Large urban centre | 34.3% | 0.150 | ||
Medium/small centre/rural area | 27.4% | |||
Lack of information | Had a prescription | 21.9% | 0.584 | |
No prescription | 48.8% | |||
Large urban centre | 28.3% | 0.010 | ||
Medium/small centre/rural area | 28.8% | |||
Intervention characteristics | % | SMD | Theme: Can’t get what I need And they’re going to take people that only take dillies like me and will not want to give me dillies because I’m not on fentanyl, I’m not on something worse (3806, had a prescription, large urban centre). A lot of people won’t take the Dexedrine because like I said before they don’t wanna wait for the time-release. (4000, no prescription, large urban centre). It’s a step in the right direction, but not nearly enough potency…The doctors need more authority to prescribe stronger narcotics… [Safer supply prescribing is] not what I need and it’s not what I want. But it’s what will have to do for now… It’s not smokeable (2446, had a prescription, medium/smaller centre/rural area) They make it hard for people like me because I get a pension from WorkSafe because I got hurt at work. That pension negates me from like a lot of the social programming. I can’t get housing, I can’t get medications covered. It’s like a big, huge clusterfuck. (3794, had a prescription, large urban centre) | |
Desired medication not available | Had a prescription | 42.2% | 0.280 | |
No prescription | 56.1% | |||
Large urban centre | 44.9% | 0.061 | ||
Medium/small centre/rural area | 48.0% | |||
Cost | Had a prescription | 14.1% | 0.401 | |
No prescription | 30.5% | |||
Large urban centre | 18.1% | 0.008 | ||
Medium/small centre/rural area | 17.8% | |||
Individual characteristics | % | SMD | Theme: Anxieties, worries and doubts Was going out in public. You don’t really want to go out when you look sick or anything. (2361, had a prescription, large urban centre) I think my doctor, personally my doctor is a pretty cool guy. But I think I would be okay. I just don’t know why. I think I was just more worried about, like, what if he thinks that… I always have that thing in my head “what if he thinks that I just want them for – I just want more drugs?” You know? I always have that in the back of my head. (2890, no prescription, setting missing) Because our lives are pretty, you know, full turmoil and what not. (3794, had a prescription, large urban centre) It’s the only reason I haven’t got my supply yet…I think just work [is holding me back] and…wanting to go through my GP but having doubts as well that she’ll do it. Are they supposed to? How does it work? Does she have to, or no?… I’m not really sure. In my past, every GP I’ve had has come with a disclaimer that they won’t prescribe opiates. Like it’s been 3 now. (3494, no prescription, large urban centre) | |
Health concerns | Had a prescription | 39.1% | 0.639 | |
No prescription | 69.5% | |||
Large urban centre | 45.7% | 0.073 | ||
Medium/small centre/rural area | 49.3% | |||
Don’t trust health care | Had a prescription | 28.5% | 0.348 | |
No prescription | 45.1% | |||
Large urban centre | 32.5% | 0.009 | ||
Medium/small centre/rural area | 32.9% | |||
Too busy | Had a prescription | 24.6% | 0.490 | |
No prescription | 47.6% | |||
Large urban centre | 28.7% | 0.148 | ||
Medium/small centre/rural area | 35.6% | |||
Don’t think it will work | Had a prescription | 19.1% | 0.264 | |
No prescription | 30.5% | |||
Large urban centre | 21.5% | 0.042 | ||
Medium/small centre/rural area | 23.3% | |||