Safer opioid supply via a biometric dispensing machine: a qualitative study of barriers, facilitators and associated outcomes

BACKGROUND: The MySafe program provides pharmaceutical-grade opioids to participants with opioid use disorder via a biometric dispensing machine. The objectives of this study were to examine facilitators and barriers to safer supply via the MySafe program and the associated outcomes. METHODS: We conducted semistructured interviews with participants who had been enrolled in the MySafe program for at least a month at 1 of 3 sites in Vancouver. We developed the interview guide in consultation with a community advisory board. Interviews focused on context of substance use and overdose risk, enrolment motivations, program access and functionality, and outcomes. We integrated case study and grounded theory methodologies, and used both conventional and directed content analyses to guide inductive and deductive coding processes. RESULTS: We interviewed 46 participants. Characteristics that facilitated use of the program included accessibility and choice, a lack of consequences for missing doses, nonwitnessed dosing, judgment-free services and an ability to accumulate doses. Barriers included technological issues with the dispensing machine, dosing challenges and prescriptions being tied to individual machines. Participant-reported outcomes included reduced use of illicit drugs, decreased overdose risk, positive financial impacts and improvements in health and well-being. INTERPRETATION: Participants perceived that the MySafe program reduced drug-related harms and promoted positive outcomes. This service delivery model may be able to circumvent barriers that exist at other safer opioid supply programs and may enable access to safer supply in settings where programs may otherwise be limited.