{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T00:10:33Z","timestamp":1755216633416,"version":"3.43.0"},"reference-count":47,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T00:00:00Z","timestamp":1754265600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["CBR-156918"],"award-info":[{"award-number":["CBR-156918"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>Access to government-funded addiction treatment programs can reduce harms experienced by people who use substances (PWUS). There is some research on what features (e.g., policies and practices) of treatment programs help or do not help with access; however, not much is known about program directors\u2019 and physicians\u2019 perspectives of these features in Atlantic Canada. One-on-one semi-structured qualitative interviews were conducted with program directors and physicians working in government-funded addiction treatment programs in Atlantic Canada in 2021. Interview questions focused on perspectives of program features that helped or not with access and retention, including perspectives on changes due to COVID-19. Data were coded and analyzed using grounded theory techniques to develop themes and subthemes. Fourteen individuals were interviewed. They identified several features that helped (e.g., quick access) or did not help (e.g., wait times) with access and retention. Participants shared some features that changed due to COVID-19, including some that helped (e.g., virtual services) and did not (e.g., limited program spaces). Participants suggested changes that could support access and retention, including better linkages to mental health supports. This paper highlights program directors\u2019 and physicians\u2019 perspectives on how program features inform access and retention in Atlantic Canada. Findings on changes made during COVID-19 point to the need to maintain the changes that were helpful and implement additional changes to better support access for more PWUS. To support the implementation and sustainability of these changes, more resources must be invested.<\/jats:p>","DOI":"10.1371\/journal.pone.0328524","type":"journal-article","created":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T17:23:11Z","timestamp":1754328191000},"page":"e0328524","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Features of drug addiction treatment programs in Atlantic Canada that help (or not) with access and retention: A qualitative study"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0094-2466","authenticated-orcid":true,"given":"Holly","family":"Mathias","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lois A.","family":"Jackson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jane A.","family":"Buxton","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anik","family":"Dub\u00e9","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Niki","family":"Kiepek","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jo-Ann","family":"MacDonald","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fiona","family":"Martin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jen","family":"Smith","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,8,4]]},"reference":[{"key":"pone.0328524.ref001","unstructured":"Canadian Public Health Association. Framework for a public health approach to substance use [Internet]. Ottawa: Canadian Public Health Association; 2024 [cited 2025 Jan 10]. Available from: https:\/\/www.cpha.ca\/framework-public-health-approach-substance-use"},{"key":"pone.0328524.ref002","unstructured":"Special Advisory Committee on the Epidemic of Opioid Overdoses. Opioid- and stimulant-related harms in Canada [Internet]. Ottawa: Public Health Agency of Canada; 2024 [cited 2025 Jan 21]. Available from: https:\/\/health-infobase.canada.ca\/substance-related-harms\/opioids-stimulants\/"},{"key":"pone.0328524.ref003","doi-asserted-by":"crossref","DOI":"10.18356\/9789211065534","volume-title":"World drug report 2024 [Internet]","author":"United Nations Office on Drugs and Crime","year":"2024"},{"key":"pone.0328524.ref004","unstructured":"World Health Organization. The public health dimension of the world drug problem [Internet]. Geneva: World Health Organization; 2019 [cited 2025 Feb 10]. Available from: https:\/\/iris.who.int\/bitstream\/handle\/10665\/311674\/WHO-MVP-EMP-2019.02-eng.pdf?sequence=5"},{"issue":"5","key":"pone.0328524.ref005","doi-asserted-by":"crossref","DOI":"10.1016\/S2214-109X(23)00057-8","article-title":"Epidemiology of injecting drug use, prevalence of injecting-related harm, and exposure to behavioural and environmental risks among people who inject drugs: a systematic review","volume":"11","author":"L Degenhardt","year":"2023","journal-title":"The Lancet Global Health"},{"key":"pone.0328524.ref006","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.drugalcdep.2016.11.029","article-title":"A systematic review of injecting-related injury and disease among people who inject drugs","volume":"171","author":"S Larney","year":"2017","journal-title":"Drug Alcohol Depend"},{"issue":"3","key":"pone.0328524.ref007","article-title":"Health, polysubstance use, and criminal justice involvement among adults with varying levels of opioid use","volume":"1","author":"TNA Winkelman","year":"2018","journal-title":"JAMA Netw Open"},{"key":"pone.0328524.ref008","unstructured":"Health Canada. Opioid use disorder and treatment. Government of Canada; 2024 [cited 2025 June 20]. Available from: https:\/\/www.canada.ca\/en\/health-canada\/services\/opioids\/opioids-use-disorder-treatment.html"},{"issue":"4","key":"pone.0328524.ref009","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1097\/CXA.0000000000000161","article-title":"A national environmental scan of public withdrawal management services in Canada","volume":"13","author":"B Rush","year":"2022","journal-title":"Can J Addict"},{"issue":"1","key":"pone.0328524.ref010","doi-asserted-by":"crossref","DOI":"10.1186\/s13011-018-0164-3","article-title":"Use of withdrawal management services among people who use illicit drugs in Vancouver, Canada","volume":"13","author":"S Vipler","year":"2018","journal-title":"Subst Abuse Treat Prev Policy"},{"volume-title":"Environmental scan of withdrawal management practices and services in Canada: response to opioid use disorder","year":"2021","author":"B Rush","key":"pone.0328524.ref011"},{"key":"pone.0328524.ref012","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.drugalcdep.2015.12.021","article-title":"Opioid substitution therapy: lowering the treatment thresholds","volume":"161","author":"G Kourounis","year":"2016","journal-title":"Drug Alcohol Depend"},{"key":"pone.0328524.ref013","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.drugalcdep.2018.04.029","article-title":"Improved treatment-retention for patients receiving methadone dosing within the clinic providing physician and other health services (onsite) versus dosing at community (offsite) pharmacies","volume":"191","author":"G Gauthier","year":"2018","journal-title":"Drug Alcohol Depend"},{"key":"pone.0328524.ref014","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/j.drugpo.2019.07.006","article-title":"Legal and policy changes urgently needed to increase access to opioid agonist therapy in the United States","volume":"73","author":"CS Davis","year":"2019","journal-title":"Int J Drug Policy"},{"key":"pone.0328524.ref015","doi-asserted-by":"crossref","first-page":"209270","DOI":"10.1016\/j.josat.2023.209270","article-title":"\u201cI think we\u2019re getting better but we\u2019re still not there\u201d: Provider-based stigma and perceived barriers to care for people who use opioids (PWUO)","volume":"159","author":"K McLean","year":"2024","journal-title":"J Subst Use Addict Treat"},{"key":"pone.0328524.ref016","doi-asserted-by":"crossref","first-page":"104291","DOI":"10.1016\/j.drugpo.2023.104291","article-title":"Waiting for inpatient detoxification: a qualitative analysis of patient experiences","volume":"123","author":"J Neale","year":"2024","journal-title":"Int J Drug Policy"},{"issue":"1","key":"pone.0328524.ref017","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-021-12104-w","article-title":"A qualitative examination of substance use service needs among people who use drugs (PWUD) with treatment and service experience in Ontario, Canada","volume":"21","author":"C Russell","year":"2021","journal-title":"BMC Public Health"},{"key":"pone.0328524.ref018","article-title":"\u201cDon\u2019t judge a book by its cover\u201d: a qualitative study of methadone patients\u2019 experiences of stigma","volume":"11","author":"J Woo","year":"2017","journal-title":"Subst Abuse"},{"issue":"12","key":"pone.0328524.ref019","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0225548","article-title":"Assessing service and treatment needs and barriers of youth who use illicit and non-medical prescription drugs in Northern Ontario, Canada","volume":"14","author":"C Russell","year":"2019","journal-title":"PLoS ONE"},{"issue":"2","key":"pone.0328524.ref020","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0317967","article-title":"Potential improvement in spatial accessibility of methadone treatment with integration into other outpatient substance use disorder treatment programs, New York City, 2024","volume":"20","author":"MA Bachhuber","year":"2025","journal-title":"PLoS ONE"},{"issue":"3","key":"pone.0328524.ref021","doi-asserted-by":"crossref","first-page":"117","DOI":"10.4103\/cjrm.cjrm_56_23","article-title":"\u2018I\u2019m on the coast and I\u2019m on methadone\u2019: a qualitative study examining access to opioid agonist treatment in rural and coastal British Columbia","volume":"29","author":"K Hodgson","year":"2024","journal-title":"Can J Rural Med"},{"issue":"1","key":"pone.0328524.ref022","doi-asserted-by":"crossref","DOI":"10.1186\/s12954-023-00795-w","article-title":"A qualitative exploration of barriers and facilitators to drug treatment services among people who inject drugs in West Virginia","volume":"20","author":"AK Winiker","year":"2023","journal-title":"Harm Reduct J"},{"issue":"6","key":"pone.0328524.ref023","first-page":"550","article-title":"Accessing drug treatment programs in Atlantic Canada: the experiences of people who use substances","volume":"30","author":"LA Jackson","year":"2022","journal-title":"Drugs: Educ Prev Policy"},{"issue":"1","key":"pone.0328524.ref024","doi-asserted-by":"crossref","DOI":"10.1186\/s13011-024-00602-0","article-title":"What features of drug treatment programs help, or not, with access? a qualitative study of the perspectives of family members and community-based organization staff in Atlantic Canada","volume":"19","author":"H Mathias","year":"2024","journal-title":"Subst Abuse Treat Prev Policy"},{"key":"pone.0328524.ref025","unstructured":"Statistics Canada. Population estimates, quarterly (Tables 17-10-0009-01) [Internet]. Ottawa: Statistics Canada; 2024 [cited 2025 Feb 10]. Available from: https:\/\/doi.org\/10.25318\/1710000901-eng"},{"key":"pone.0328524.ref026","unstructured":"Poitra B. Up to 200 people waiting for months for addiction treatment, minister says. CBC New Brunswick; 2024 [cited 2025 June 20]. https:\/\/www.cbc.ca\/news\/canada\/new-brunswick\/200-people-waiting-months-addiction-treatment-new-brunswick-1.7162419"},{"key":"pone.0328524.ref027","unstructured":"Province of Nova Scotia. Wait times \u2013 Mental health and addictions adult services [Internet]. 2025 [cited 2025 June 24]. Available from: https:\/\/waittimes.novascotia.ca\/procedure\/mental-health-addictions-adult-services#waittimes-non-urgent"},{"issue":"9","key":"pone.0328524.ref028","doi-asserted-by":"crossref","first-page":"1245","DOI":"10.1097\/ACM.0000000000000388","article-title":"Standards for reporting qualitative research","volume":"89","author":"BC O\u2019Brien","year":"2014","journal-title":"Acad Med"},{"key":"pone.0328524.ref029","unstructured":"ATLAS.ti Scientific Software Development GmbH. ATLAS.ti Windows. Version 9.1.0 [Qualitative data analysis software]. 2021 [cited 2025 Feb 10]. Available from: https:\/\/atlasti.com"},{"key":"pone.0328524.ref030","doi-asserted-by":"crossref","DOI":"10.1016\/0147-1767(85)90062-8","volume-title":"Naturalistic inquiry","author":"YS Lincoln","year":"1985"},{"issue":"4","key":"pone.0328524.ref031","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1081\/JA-120002807","article-title":"Canadian illicit opiate users\u2019 views on methadone and other opiate prescription treatment: an exploratory qualitative study","volume":"37","author":"B Fischer","year":"2002","journal-title":"Subst Use Misuse"},{"issue":"4","key":"pone.0328524.ref032","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1177\/002204260603600404","article-title":"Waiting time as a barrier to treatment entry: perceptions of substance users","volume":"36","author":"C Redko","year":"2006","journal-title":"J Drug Issues"},{"key":"pone.0328524.ref033","doi-asserted-by":"crossref","first-page":"109049","DOI":"10.1016\/j.drugalcdep.2021.109049","article-title":"The impact of COVID-19 on opioid treatment programs in the United States","volume":"228","author":"LA Goldsamt","year":"2021","journal-title":"Drug Alcohol Depend"},{"key":"pone.0328524.ref034","doi-asserted-by":"crossref","first-page":"108223","DOI":"10.1016\/j.jsat.2020.108223","article-title":"Re-thinking patient stability for methadone in opioid treatment programs during a global pandemic: provider perspectives","volume":"124","author":"MA Hatch-Maillette","year":"2021","journal-title":"J Subst Abuse Treat"},{"key":"pone.0328524.ref035","doi-asserted-by":"crossref","first-page":"108374","DOI":"10.1016\/j.jsat.2021.108374","article-title":"Identifying the impacts of the COVID-19 pandemic on service access for people who use drugs (PWUD): a national qualitative study","volume":"129","author":"C Russell","year":"2021","journal-title":"J Subst Abuse Treat"},{"key":"pone.0328524.ref036","doi-asserted-by":"crossref","first-page":"108801","DOI":"10.1016\/j.jsat.2022.108801","article-title":"Treatment retention, return to use, and recovery support following COVID-19 relaxation of methadone take-home dosing in two rural opioid treatment programs: a mixed methods analysis","volume":"141","author":"KA Hoffman","year":"2022","journal-title":"J Subst Abuse Treat"},{"key":"pone.0328524.ref037","doi-asserted-by":"crossref","first-page":"108544","DOI":"10.1016\/j.jsat.2021.108544","article-title":"The impact of COVID-19 on substance use disorder treatment in California: service providers\u2019 perspectives","volume":"133","author":"C Lin","year":"2022","journal-title":"J Subst Abuse Treat"},{"key":"pone.0328524.ref038","doi-asserted-by":"crossref","first-page":"108514","DOI":"10.1016\/j.jsat.2021.108514","article-title":"Perspectives of opioid use disorder treatment providers during COVID-19: adapting to flexibilities and sustaining reforms","volume":"132","author":"PC Treitler","year":"2022","journal-title":"J Subst Abuse Treat"},{"key":"pone.0328524.ref039","unstructured":"Health PEI. Mental health and addictions emergency department and short stay unit [Internet]. Charlottetown: Health PEI; 2024 [cited 2025 Feb 10]. Available from: https:\/\/www.princeedwardisland.ca\/en\/information\/health-pei\/mental-health-and-addictions-emergency-department-short-stay-unit."},{"issue":"1","key":"pone.0328524.ref040","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1097\/ADM.0000000000000810","article-title":"Peer recovery support services across the continuum: in community, hospital, corrections, and treatment and recovery agency settings \u2013 a narrative review","volume":"16","author":"E Stack","year":"2021","journal-title":"J Addict Med"},{"volume-title":"Education, certification, and roles of peer providers: Lessons from four states","year":"2015","author":"S Chapman","key":"pone.0328524.ref041"},{"key":"pone.0328524.ref042","doi-asserted-by":"crossref","DOI":"10.1016\/j.amepre.2018.03.010","article-title":"Peer workers in the behavioral and integrated health workforce: opportunities and future directions","volume":"54","author":"CA Gagne","year":"2018","journal-title":"Am J Prev Med"},{"issue":"1","key":"pone.0328524.ref043","doi-asserted-by":"crossref","DOI":"10.1186\/s12954-023-00883-x","article-title":"Peer-led safer supply and opioid agonist treatment medication distribution: a case study from rural British Columbia","volume":"20","author":"M Scow","year":"2023","journal-title":"Harm Reduct J"},{"key":"pone.0328524.ref044","unstructured":"Government of British Columbia. Province expands access to opioid agonist treatment medications [Internet]. Victoria: Government of British Columbia; 2023 [cited 2025 Feb 10]. Available from: https:\/\/news.gov.bc.ca\/releases\/2023MMHA0036-000933#:~:text=Effective%20June%206%2C%202023%2C%20opioid,medical%20services%20plan%20(MSP)"},{"issue":"1","key":"pone.0328524.ref045","doi-asserted-by":"crossref","DOI":"10.1186\/s13011-024-00593-y","article-title":"Referral to and engagement in substance use disorder treatment within opioid intervention courts in New York: a qualitative study of implementation barriers and facilitators","volume":"19","author":"MA O\u2019Grady","year":"2024","journal-title":"Subst Abuse Treat Prev Policy"},{"key":"pone.0328524.ref046","article-title":"\u201cJust be relentless,\u201d lessons learned from in-hospital addiction consult service implementation","author":"BE Williams","year":"2025","journal-title":"J Gen Intern Med"},{"key":"pone.0328524.ref047","unstructured":"Office of Audit and Evaluation, Health Canada and Public Health Agency of Canada. Horizontal evaluation of the Canadian Drugs and Substances Strategy [Internet]. Ottawa: Health Canada; 2023 [cited 2025 Feb 10]. Available from: https:\/\/www.canada.ca\/content\/dam\/hc-sc\/documents\/corporate\/transparency\/corporate-management-reporting\/evaluation\/canadian-drugs-substances-strategy\/canadian-drugs-substances-strategy.pdf"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0328524","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T17:23:19Z","timestamp":1754328199000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0328524"}},"subtitle":[],"editor":[{"given":"Azad","family":"Haider","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,8,4]]},"references-count":47,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2025,8,4]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0328524","relation":{},"ISSN":["1932-6203"],"issn-type":[{"type":"electronic","value":"1932-6203"}],"subject":[],"published":{"date-parts":[[2025,8,4]]}}}