Perceived Barriers and Potential Strategies for People Who Use Drugs in Accessing Oral Healthcare: A Qualitative Study of Service Providers.

Abstract

Objective: Access to appropriate oral healthcare is vital for overall health and well-being. However, people who use drugs (PWUD) often face significant barriers in accessing oral healthcare services. This qualitative study focused on exploring the perspectives of public oral health service providers and harm reduction workers to understand the barriers that they perceived were experienced by PWUD in accessing oral healthcare and identified potential strategies to address these barriers.

Method: Thirty-five participants (20 public oral health service providers and 15 harm reduction workers) were recruited from both metropolitan and regional areas of Victoria, Australia, through purposive sampling and a snowballing technique. Individual online semi-structured interviews were conducted, and data were analysed using a hybrid approach to thematic analysis.

Results: Service providers felt that continuous drug use impacted PWUD's ability to perceive dental pain, which delayed identification of oral health symptoms at the individual level. Major life crises meant that PWUD had limited awareness about the oral health consequences of their drug use, which further hindered their access to care. Service providers described how negative experiences and perceived judgements by PWUD about the visual effects of drugs created barriers to accessing dental care. Triggers of memories of traumatic abuse associated with the dental environments were also identified as a distressing factor for PWUD. Perceived service-level barriers included the lack of explicit recognition of PWUD as eligible for priority access in public dental clinics, financial impediments and coercive tactics from some oral health service providers. Service providers with experience of working in rural areas shared how the lack of anonymity and the risk of being identified as a drug user was an additional challenge for PWUD in accessing oral health services in rural areas. The participants proposed several potential strategies including drop-in oral health sessions at harm reduction facilities involving case managers to address appointment issues and training oral health service providers in trauma-informed care. They emphasised the need for interprofessional collaboration between oral health and harm reduction sectors. One key recommendation proposed by the participants was to establish oral health integrated harm reduction programmes that require careful consideration of feasibility, acceptability, resource allocation and potential implications on service quality.

Conclusion: This study highlighted previously unrecognised perceived barriers by service providers working with PWUD that could impact the implementation of any interventions that aim to improve access to dental services by PWUD. By addressing the individual and service level barriers comprehensively, healthcare systems can better address the oral health needs of PWUD and reduce disparities in access to care.