Anna Conway is a PhD student at The Kirby Institute and Centre for Social Research in Health, UNSW Sydney

Background
Opioid agonist treatment (OAT) is associated with reduced risk of drug-related mortality and other positive health outcomes. Restrictive and burdensome models of OAT provision present a barrier to access. The removal or reduction of potentially hazardous approaches to care (deimplementation), is key to progressing social equity in healthcare. During the COVID-19 pandemic in Australia, services deimplemented aspects of OAT provision: supervised dosing, urine drug screening, and frequent in-person attendance for review. This study examined how providers considered social inequity in relation to deimplementation of restrictive OAT provision during the COVID-19 pandemic.
Methods
Between August and December 2020, semi-structured interviews were conducted with 29 OAT providers. Data were coded with the social determinants of retention in OAT, then grouped according to how providers linked deimplementation to social inequities in health. The analysis explores how providers understood their work during the COVID-19 pandemic as responding to systemic issues that condition OAT access.
Findings
Providers adapted the deimplementation process in response to perceived social inequities. The adaptations sometimes threatened patient autonomy e.g. by not allowing reduced in-person attendance for dosing for people engaged in hepatitis C treatment. Providers reflected on their professional identity and the organisational identity, facilitating rapid changes within the OAT services. Clinic champions, or providers who had long supported deimplementation to achieve more humane care, were key actors in service change during the COVID-19 pandemic. Several providers expressed discomfort at sustaining deimplementation long term and called for narrowly defined types of data on adverse events and expert consensus on takeaway doses.
Conclusion
Providers linked social equity in health to their work despite equity not being embedded in the planning of service adaptions/modifications. Sustained and equitable deimplementation of obtrusive aspects of OAT provision require patient-centred planning, monitoring and evaluation, and access to a supportive community of practice for providers.