Background:
Injectable Opioid Agonist Treatment (iOAT) is a crucial intervention for severe Opioid Use Disorder (OUD). Despite its effectiveness, iOAT is often inaccessible for people with disabilities due to the rigid clinic-based approach, requiring daily attendance. This study investigates the accessibility barriers in iOAT and evaluates the impact of take-home doses on treatment engagement, autonomy, and overall well-being.

Methods:
This study was conducted in Vancouver, Canada, between 2021 and 2022. We conducted 23 qualitative interviews with clients receiving iOAT through traditional clinic-based models, take-home doses, or delivery services during the COVID-19 pandemic. Participants were recruited from various iOAT clinics. Interviews explored treatment accessibility, including physical barriers, stigma, and mental health challenges, and assessed how take-home dosing affected clients' lives. Data were analyzed using a critical realist approach and abductive coding, focusing on accessibility and client autonomy.

Results:
Participants identified significant barriers to traditional iOAT, including physical challenges like navigating broken elevators and inaccessible sidewalks, as well as chronic pain and anxiety. Treatment attendance was further hindered by drug- and treatment-related stigma, alongside fears of discrimination from employers and in social settings. In contrast, take-home iOAT significantly increased accessibility, providing clients with a sense of freedom, dignity, autonomy, and more free time. This flexibility led to greater emotional well-being, reduced stigma, and enhanced social fulfillment.

Conclusions:
Take-home iOAT addresses many accessibility challenges, offering a more flexible, person-centered approach to care. Expanding access to take-home doses aligns with human rights principles by promoting autonomy, dignity, and equitable healthcare. Policy reforms are needed to ensure wider availability, improving treatment retention and reducing reliance on unregulated drug supplies.