“We need all the help we can get”: A Qualitative Examination of Service Provider Perspectives on the Barriers and Facilitators to the Implementation of The Emergency Risk Mitigation Guidelines




Kalicum, Jeremy

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The Risk Mitigation Guidance (RMG) was an interim clinical guidance implemented to respond to both the public health emergency on COVID-19 and the overdose crisis through the provision of pharmaceutical alternatives to the illicit drug supply to facilitate isolation, social distancing, and reduce overdose risk. This study analysed the perspectives from a broad range of service providers, whose work was impacted or related to the RMG, to elucidate a nuanced narrative regarding the perceived facilitators and barriers to RMG implementation. In this study, 24 qualitative interviews were conducted with service providers with the RMG from across British Columbia. Service Providers viewed RMG as a tangible item they could refer to when providing RMG medications to people who clearly fit in the intended target populations. Implementation challenges included, lack of comprehensive guidance and support, inconsistent application of RMG, historical prescribing contexts, the potential risk of destabilizing people on alternative treatments, and diversion. Future research is needed in determining the qualitative and quantitative impacts of pharmaceutical alternative initiatives, particularly in relation to diversion and the initiation of substance use; the relative impact of increased planning in the context of public health emergencies; and deeper analysis into the perspectives of other stakeholders, such as PWUD or pain patients, on the implementation of pharmaceutical alternatives.



Risk Mitigation Guidance, pharmaceutical alternatives, safe supply, COVID-19, clinical guidance, emergency response, harm reduction, implementation science, Consolidated Framework for Implementation Research