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Table 4 Summary of barriers and facilitators across key themes

From: Challenges for the implementation of injectable opioid agonist treatment: a scoping review

Theme

Barriers

Facilitators

Public acceptance

− Public safety concerns (e.g., influx of PWUD, visibility of ‘scene’)

− Concerns about crime, “Honey-Pot effect”

− Increased demand for drug services

− Stigma surrounding injection drug use

− Promotion of permissive drug use attitudes

− Strict residency criteria for participants

− Limited number of participants

− Collaboration with local law enforcement

− High-threshold treatment programs

− Comprehensive drug policy frameworks (e.g., Switzerland)

− Development of infrastructure and security measures

Legal and ethical considerations

− Legal barriers to prescription (prohibition of DAM for iOAT in most countries)

− Stringent legal and regulatory requirements (dosage, formulation, administration)

− Ethical concerns about patient consent and transitioning back to oral OAT

− Tension between client needs and system requirements

− Changes in laws to allow DAM prescription

− National ethics committees ensuring compliance with consent, autonomy, and protection protocols

− Methodological standards imposed by ethics committees

− Frameworks to reconcile patient autonomy with public acceptance concerns

Media coverage and interest groups

− Negative media campaigns (e.g., defamation, misinformation)

− Public fears over “drug tourism” and stigma around heroin use

− Moral outrage in public discourse

− Resistance from abstinence advocates and political groups

− Comprehensive information strategies (e.g., publishing reports, organizing events)

− Involvement of family members of people with an OUD and community in media strategies

− Addressing opponents’ arguments proactively

− Emphasizing moral responsibility and public health advocacy

Long-term implementation costs and benefits

− High start-up costs (staffing, recruitment, infrastructure)

− Limited long-term economic justification for iOAT

− Structural challenges (space, equipment)

− Limited resources and political decisions affecting sustainability

− Demonstrated cost-effectiveness of iOAT (reduced crime, law enforcement costs)

− Political support for long-term funding

− Economic evaluations

− Funding strategies, ringfenced funding, and capacity-building initiatives

Patients’ and providers’ perspectives

− Structural weaknesses in conventional treatment

− Regulatory barriers (e.g., daily supervision, dose restrictions)

− Reluctance among PWID to switch to iOAT

− Concerns about infection risks and attachment to oral OAT rituals

− Patient-centered care (e.g., incorporating patient preferences in treatment decisions)

− Flexibility in delivery protocols (e.g., take-home doses)

− Peer support networks to engage harder-to-reach individuals

− Inclusive spaces for women and gender-specific services

− Interdisciplinary support

  1. OAT opioid agonist treatment, iOAT injectable opioid agonist treatment, OUD opioid use disorder, PWUD people who use drugs, PWID people who inject drugs