Uncovered, underfunded, and undervalued: How policy contexts shape knowledge production in multi-site substance use...

Area of Science:

• Substance Use Research
• Clinical Trials
• Health Policy

Background:

• Pragmatic trials assess treatment effectiveness in real-world settings.
• Substance use research is influenced by structural stigma, drug policies, and public perceptions that vary by location.
• Localized contextual factors can affect participant experiences and outcomes in multisite trials.

Purpose of the Study:

• To investigate how jurisdictional differences in treatment policies shape pragmatic trial experiences for people who use drugs.
• To understand the impact of structural stigma and localized policies on the conduct and interpretation of multisite substance use trials.

Main Methods:

• Nested qualitative study within a pragmatic randomized controlled trial for opioid use disorder.
• Analysis of 115 semi-structured interviews from 75 participants across four Canadian provinces.
• Flexible coding and thematic analysis to identify patterns in participant experiences.

Main Results:

• Participants in Alberta faced treatment interruption due to restrictive income assistance policies affecting medication coverage.
• Long wait times for medications in Ontario and Quebec motivated trial enrollment as a faster care pathway.
• Participants in British Columbia reported concerns with medication formulations and limited access to new treatments.

Conclusions:

• Jurisdictional policy contexts and structural stigma directly influence participant experiences in substance use treatment trials.
• These site-specific dynamics complicate trial conduct and the interpretation of findings.
• Multisite trial results must be considered within their specific policy and stigma contexts.