Implementation of pharmaceutical alternatives to a toxic drug supply in British Columbia: A mixed methods study

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dc.contributor.authorPauly, Bernie
dc.contributor.authorKurz, Megan
dc.contributor.authorDale, Laura M.
dc.contributor.authorMacevicius, Celeste
dc.contributor.authorKalicum, Jeremy
dc.contributor.authorPérez, Daniel Gudiño
dc.contributor.authorMcCall, Jane
dc.contributor.authorUrbanoski, Karen
dc.contributor.authorBarker, Brittany
dc.contributor.authorSlaunwhite, Amanda
dc.contributor.authorLindsay, Morgan
dc.contributor.authorNosyk, Bohdan
dc.date.accessioned2025-03-18T16:02:05Z
dc.date.available2025-03-18T16:02:05Z
dc.date.issued2024
dc.description.abstractBackground North America has been in an unrelenting overdose crisis for almost a decade. British Columbia (BC), Canada declared a public health emergency due to overdoses in 2016. Risk Mitigation Guidance (RMG) for prescribing pharmaceutical opioids, stimulants and benzodiazepine alternatives to the toxic drug supply (“safer supply”) was implemented in March 2020 in an attempt to reduce harms of COVID-19 and overdose deaths in BC during dual declared public health emergencies. Our objective was to describe early implementation of RMG among prescribers in BC. Methods We conducted a convergent mixed methods study drawing population-level linked administrative health data and qualitative interviews with 17 prescribers. The Consolidated Framework for Implementation Research (CFIR) informs our work. The study utilized seven linked databases, capturing the characteristics of prescribers for people with substance use disorder to describe the characteristics of those prescribing under the RMG using univariate summary statistics and logistic regression analysis. For the qualitative analysis, we drew on interpretative descriptive methodology to identify barriers and facilitators to implementation. Results Analysis of administrative databases demonstrated limited uptake of the intervention outside large urban centres and a highly specific profile of urban prescribers, with larger and more complex caseloads associated with RMG prescribing. Nurse practitioners were three times more likely to prescribe than general practitioners. Qualitatively, the study identified five themes related to the five CFIR domains: 1) RMG is helpful but controversial; 2) Motivations and challenges to prescribing; 3) New options and opportunities for care but not enough to ‘win the arms race’; 4) Lack of implementation support and resources; 5) Limited infrastructure. Conclusions BC's implementation of RMG was limited in scope, prescriber uptake and geographic scale up. Systemic, organizational and individual barriers and facilitators point to the importance of engaging professional regulatory colleges, implementation planning and organizational infrastructure to ensure effective implementation and adaptation to context.
dc.description.sponsorshipThis work was supported by Canadian Institutes of Health Research (CIHR, grant number 172 671), Michael Smith Health Research, Victoria Hospital Foundation, and BC Ministry of Health. AS is supported by a Scholar Award from the Michael Smith Health Research. KU is supported by a Canada Research Chair through CIHR. BP was supported by an Island Health Scholar in Residence Award.
dc.identifier.citationPauly, B., Kurz, M., Dale, L. M., Macevicius, C., Kalicum, J., Pérez, D. G., McCall, J., Urbanoski, K., Barker, B., Slaunwhite, A., Lindsay, M., & Nosyk, B. (2024). Implementation of pharmaceutical alternatives to a toxic drug supply in British Columbia: A mixed methods study. Journal of Substance Use and Addiction Treatment, 161, 209341. https://doi.org/10.1016/j.josat.2024.209341
dc.identifier.urihttps://doi.org/10.1016/j.josat.2024.209341
dc.identifier.urihttps://hdl.handle.net/1828/21669
dc.language.isoen
dc.publisherJournal of Substance Use and Addiction Treatment
dc.rightsCC BY-NC-ND 4.0
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/
dc.subjectConsolidated Framework for Implementation Research
dc.subjectharm reduction
dc.subjectimplementation science
dc.subjectprescribed safer supply
dc.subjectrisk mitigation guidance
dc.subjectsubstance use disorder
dc.titleImplementation of pharmaceutical alternatives to a toxic drug supply in British Columbia: A mixed methods study
dc.typeArticle

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