The characteristics and experiences of parents accessing prescribed safer supply in BC, 2020-2021

The characteristics and experiences of parents accessing prescribed safer supply in BC, 2020-2021 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Short Report The characteristics and experiences of parents accessing prescribed safer supply in BC, 2020-2021 Katherine Hogan, Celeste Macevicius, Taija McLuckie, Jenny McDougall, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7820725/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Objectives In 2020, British Columbia implemented prescribed safer supply (PSS) to reduce harms associated with the toxic drug supply. Evidence is emerging on these programs; however, no studies to date have focused on exploring the experiences of parents accessing or attempting to access PSS, including differences between parents and non-parents in reported barriers. Methods This mixed-methods study used data from a cross-sectional survey (n = 353) with people who had received or were seeking PSS recruited between October 2020–2021. Semi-structured interviews were completed with a subset of survey respondents (n = 16) who reported having children under age 19. We conducted a descriptive analysis of survey data on barriers to care, and a secondary thematic analysis of interviews on parents’ experiences of PSS informed by an ecological model. Results Among 353 recruited, 31.4% of participants reported having a child under age 19. All participants reported barriers to PSS; however, parents were more likely to report being too busy compared to non-parents (41.4% vs. 25.4%, p = 0.003). Ecological themes describing parents’ experiences of PSS reflected: ( 1 ) unique interpersonal motivations for accessing PSS, such as to participate in children’s lives and protect them from potential harms and ( 2 ) parenting-associated policy barriers, including fear child welfare reports and competing time demands. Discussion Parents reported unique interpersonal motivations and policy challenges when accessing PSS. These findings highlight the need to address stigmatizing, punitive responses to families experiencing substance use and support approaches that are parent-centered and inclusive of the family across a continuum of care. Prescribed Safer Supply Parenting Harm Reduction Substance use child welfare system British Columbia Canada Introduction In 2016, the Public Health Officer of British Columbia (BC) declared a public health emergency to due to the exponential rise in toxic drug fatalities, driven by the proliferation of illicitly-manufactured fentanyl in the street supply ( 1 ). Over 13,000 people have since died as the crisis continues ( 1 ). In 2020, the BC government approved the Risk Mitigation Guidance (RMG) as a response to the dual public health emergencies of COVID-19 and an increasingly toxic drug supply. The RMG supported clinicians to prescribe alternatives to unregulated drugs, a form of prescribed safer supply (PSS) ( 2 ). The toxic drug supply crisis has had devastating and intergenerational impacts on families and kinship networks. In the United States, an estimated 321,566 children lost a parent to overdose between 2011–2021 ( 3 ). Research shows that children of parents who use opioids often face a range of challenges, including disrupted parent-child relationships, lack of stable living conditions, and heightened vulnerability to grief and loss ( 4 , 5 ). Parents who use drugs and have had their child apprehended experience a range of negative impacts, including a heightened risk of overdose, increased drug use, poorer mental health, and decreased motivation in treatment ( 6 ). Previous research has identified unique barriers and facilitators for mothers trying to access substance use services and treatment, with little research focusing on fathers and gender diverse parents ( 4 , 6 ). Barriers parents experience include internalized stigma, substantiated concerns about (re)involvement of child welfare services or other punitive responses (e.g., forced treatment), judgement from service providers and family, fear of “failing” treatment, unwillingness to be separate from children and family during intensive treatment, transportation challenges, financial demands, time constraints, and limited availability of relevant services ( 7 – 9 ). Facilitators included motivations to be a good mother, having trusting relationships with service providers and family, assistance with transportation and childcare, collaborative care models, family-oriented programming, trauma-informed care, and parenting-specific supports ( 6 , 7 , 9 ). In Canada, while parental drug use itself is not considered a cause for child apprehension, this rationale is used frequently ( 8 ). Parental barriers to care are influenced by social and structural determinants of health and compounded for those experiencing intersecting marginalized identities (e.g., Indigenous people, ethnic and sexual minorities) ( 8 , 9 ). There are significant gaps in research about experiences of parents trying to access support for unregulated substance use, particularly for medication-assisted interventions and populations beyond women in the perinatal period ( 4 ). Indeed, given the extreme stigma associated with parenting and substance use and the over-surveillance of parents who use drugs by child welfare and healthcare services, parents remain a hidden population in substance use research. To address this gap, we undertook a study to explore differences in the experiences of parents and non-parents who accessed or tried to access a PSS under RMG. In this study, we refer to all people who have children as parents but recognize that not all individuals identify as parents or are actively parenting. Methods This study is part of a larger mixed methods evaluation of the implementation and impacts of the RMG in BC ( 10 ). The present study uses a mixed-methods design involving survey and interview data. Surveys were administered October 2020 through October 2021 primarily by phone or in-person in accordance with COVID-19 guidelines. Eligible participants were 19 or older, had used unregulated drugs in the past 6 months, and had received a safer supply prescription or were actively seeking one. We used SPSS version 30.0.0.0 (172) to run bivariate chi-square tests comparing experiences of parents and non-parents with PSS (including types and experiences with medications, barriers, and non-fatal overdoses). We conducted semi-structured interviews with a subset of survey participants (n = 54). Participants were purposively sampled to ensure representation by gender, region, and prescription type. Parenting status was not specifically targeted. Interviews were recorded and transcribed verbatim. For this study, we used the survey item on parenting status to select interviews for analysis (n = 16). Although our interview guide did not ask specific questions about parenting, we posed overarching questions about motivations, facilitators, barriers, and impacts related to PSS. Parenting-specific responses emerged to these questions in multiple interviews. We therefore conducted a thematic analysis of content related to parenting and having a child, ( 11 ) informed by the ecological model ( 12 ). The ecological model sensitized us to consider factors at the intrapersonal, interpersonal, organizational, community, and policy levels ( 12 ). This approach aligns with previous research identifying multi-level influences on parents’ experiences of substance use services ( 5 , 7 , 9 ). Study activities were approved by the University of Victoria Research Ethics Board (#20–0293). RESULTS Quantitative Findings Of the 353 survey participants, 31.4% reported children under age 19 (see ( 13 ) for a comprehensive description of this survey sample). Half (50.5%) of parents and 62.2% of non-parents were men, 40.5% and 74.2% were white, and 57.5% and 52.7% were stably housed. Among parents, 9.0% reported having full-time care of their children and the majority (65.8%) reported children were living with family members. Most (68.5% of parents and 74.2% of non-parents) had accessed PSS. No significant differences were found between parents and non-parents in the ability to access desired medication, having a sufficient dosage to prevent withdrawal, or experiencing an overdose (Table 1 ). Many barriers were commonly reported by both parents and non-parents, including mistrust of healthcare providers, past negative interactions and feeling unsafe in clinics, beliefs that PSS will not be able to meet needs, lack of knowledge of where to access PSS, perceived costs, and concerns surrounding COVID-19. The only significant difference that emerged was that parents were more likely to report being too busy as a barrier to PSS compared to non-parents (41.4% vs. 25.4%, p = 0.003). Table 1 Experiences of parents and non-parents of accessing or trying to access PSS Non-Parents Parents 𝜒² (n = 209) (n = 111) Received any prescription (n = 320) 𝜒²( 1 ) = 1.171, p = .279 No 54 (25.8) 35 (31.5) Yes 155 (74.2) 76 (68.5) Type of prescription, n (%) 1` Opioids 134 (64.1) 65 (58.6) Stimulants 42 (20.1) 19 (17.1) Benzodiazepines 6 (2.9) 2 (1.8) No prescription 54 (25.8) 35 (31.5) Able to get desired Medication (n = 227) 2 𝜒²( 1 ) = 1.368, p = .242 No 42 (27.5) 15 (20.3) Yes 111 (72.5) 59 (79.7) Dosage high enough for withdrawal (n = 225) 2 𝜒²( 1 ) = .549, p = .459 No 92 (60.1) 47 (65.3) Yes 61 (39.9) 25 (34.7) Overdose past two weeks (n = 320) 𝜒²( 1 ) = .745, p = .388 No 187 (91.2) 97 (88.2) Yes 18 (8.8) 13 (11.8) Reported barriers Covid-19 Measures n = 320 𝜒²( 1 ) = 2.154, p = .142 No 127 (60.8) 58 (52.3) Yes 82 (39.2) 53 (47.7) Fear of, or past experiences of, stigma in health care (n = 320) 𝜒²( 1 ) = .013, p = .911 No 74 (35.4) 40 (36.0) Yes 135 (64.6) 71 (64.0) Safety concerns when accessing health care (n = 320) 𝜒²( 1 ) = 1.259, p = .262 No 126 (60.3) 74 (66.7) Yes 83 (39.7) 37 (33.3) Desired PSS medication not available (n = 320) 𝜒²( 1 ) =. 204, p = .651 No 94 (45.0) 47 (42.3) Yes 115 (55.0) 64 (57.7) Previous negative reaction from a health care provider (n = 320) 𝜒²( 1 ) = .015, p = .902 No 137 (65.6) 72 (64.9) Yes 72 (34.4) 39 (35.1) Lack of information about PSS (n = 320) 𝜒²( 1 ) = 1.504, p = .220 No 153 (73.2) 74 (66.7) Yes 56 (26.8) 37 (33.3) PSS prescription Cost (n = 320) 𝜒²( 1 ) = 1.316, p = .251 No 166 (79.4) 94 (84.7) Yes 43 (20.6) 17 (15.3) Being too Busy for PSS (n = 320) 𝜒²( 1 ) = 8.776, p = .003 No 156 (74.6) 65 (58.6) Yes 53 (25.4) 46 (41.4) Health concerns (n = 320) 𝜒²( 1 ) = .084, p = .772 No 109 (52.2) 56 (50.5) Yes 100 (47.8) 55 (49.5) Don’t think PSS will work (n = 320) 𝜒²( 1 ) = 1.004 p = .307 No 157 (75.1) 89 (80.2) Yes 52 (24.9) 22 (19.8) Mistrust of health care services (n = 320) 𝜒²( 1 ) = .102, p = .749 No 143 (68.4) 74 (66.7) Yes 66 (31.6) 37 (33.3) Lack of privacy in health care services (n = 320) 𝜒²( 1 ) = 1.502, p = .220 No 160 (76.6) 78 (70.3) Yes 49 (23.4) 33 (29.7) 1 Not mutually exclusive (proportions do not sum to 100%) 2 Only respondents who reported having accessed PSS received this item / Table 1 here / Qualitative Findings Interviews were diverse with respect to gender, ethnicity, and housing stability. Two main ecological themes were identified: ( 1 ) Parents have unique interpersonal motivations for accessing prescribed safer supply ( 2 ) Parents experience specific policy and regulatory barriers to accessing prescribed safer supply. Parenting-specific interpersonal motivations in seeking PSS Some participants identified parenting-related motivations as reasons to pursue or stay on PSS. One motivation identified was improving the quality of the role parents had in their children’s lives: “I’d like to get back to a point in my life where I can be a functioning part of my daughter’s life” (participant 3827). PSS was seen as a pathway to improve stability and therefore support more active engagement with their children. Another motivation was that PSS was viewed as providing separation and therefore protection from the toxicity of the street supply. Parents acknowledged that accessing the unregulated drug market could negatively impact their children: “I don’t want to die over this. […] I don’t want to leave that legacy for my kids” (participant 2524) and expressed a need to have ways to avoid these harms. PSS was seen as one way to prevent harm, including children being exposed to a parent in withdrawal, “I don’t ever want… my son to see me sick. Ever” (participant 2565). Together, these quotes underline the intergenerational impacts of the toxic drug crisis and parents’ motivation to protect their children from these harms. Parenting-specific policy and regulatory barriers to PSS Some participants attributed barriers to parenting when trying to access or stay on PSS, however many barriers are the result of regulatory policies and procedures that exist within the current systems of care. One parent described fear that disclosing their substance use and accessing PSS would lead their healthcare provider to report them to child welfare services as unfit to parent. They linked fears to past negative experiences of being engaged in substance use treatment: “ I slipped and said I was on methadone to a social worker […] She kind of went from there and decided that she’d better open up a file […] it was just like ‘Really? Because I’m being honest? So what you want me to do is lie to you?’ So that’s why I don’t trust anybody. I just have a hard time trusting anybody ” (participant 2890), emphasizing how policy systems such as child welfare can create barriers. Parents also described the challenge of balancing work and family responsibilities with having their PSS medications dispensed daily at the pharmacy. This participant had their prescription cut off when: “I was so busy working and family and stuff that I had missed two days [of dispensations]” (participant 2565), illustrating how a lack of attention and support to parents’ competing commitments and dispensation regulations can act as a barrier to staying on PSS medications. Discussion Families across BC continue to be impacted by the toxic drug crisis. We found that parents experienced many policy barriers when trying to access PSS. In the survey, parents were more likely to report being too busy to access a prescription than non-parents. This was corroborated by interview findings that parenting responsibilities impeded participants’ ability to access PSS and could result in discontinuation of prescriptions. Parenting-related time demands have likewise been identified as a barrier and potential factor for disengagement from care in existing research ( 7 , 9 ). Other barriers parents reported included fears of drug use stigma from providers, the threat of child apprehension, and a lack of child-inclusive substance use services, highlighting the significant impact of current health and legal policies on parents who uses drugs. These barriers have also been reported by parents trying to access other substance use services such as treatment, underlining the need for systems-wide change ( 7 , 9 , 14 ). Notably, parents also had unique interpersonal motivations for pursuing PSS; namely, to take a more active role in their children’s lives and protect children from harm. This suggests addressing interpersonal factors, including parent-child relationships, may be an important consideration in PSS interventions. Non-stigmatizing care, respectful treatment, and the availability of wraparound services at PSS programs such as support in obtaining, social assistance and child tax benefits, childcare, housing, and food should be extended to family networks to reduce parenting-related barriers and support families ( 15 ). Finally, we observed that men were more likely to report having a child under age 19 compared to women, yet the vast majority of research focuses on mothers who use drugs ( 4 ). The disregard of paternal needs in substance use and child welfare services is often overlooked, and this invisibility within services can further isolate fathers from children, fracture existing social networks, and prevent fathers from achieving their goals ( 14 ). Our preliminary findings highlight a gap in the literature and more data are needed to explore the unique factors impacting fathers’ access to safer supply and treatment. Limitations The survey sample is limited by the non-random sampling approach that primarily relied on connecting with participants by phone, which may have resulted in an under sampling of those who were the most marginalized. Due to small sample size, we did not stratify parents based on custody status which may influence reported barriers. We were unable to report on the interview sample characteristics because of small sample sizes. The secondary analysis of qualitative data was valuable in highlighting that parenting has multiple intersections with PSS. However, these findings should be interpreted with caution as we did not include parenting-specific questions in our study instrument and thus we were limited to analyzing parenting-related experiences that were independently raised. Conclusion The intergenerational impact on families eight years into the toxic drug crisis continues. These findings highlight some of the challenges as well as motivations that parents who use drugs, including both fathers and mothers, experience when trying to access PSS and other substance use services. We recommend prioritizing parent-centered goals and echo calls for research, policy and programming that takes the entire family network into account ( 3 , 9 ). Declarations Acknowledgments: This research took place on the unceded territories of the Lək̓ʷəŋən (Songhees and Xʷsepsəm/Esquimalt) and W̱SÁNEĆ Peoples where the University of Victoria is located. Data were collected from the over 200 distinct First Nations in what is colonially known as British Columbia. This study was funded by Canadian Institutes of Health Research (#172 671), the Victoria Hospital Foundation and the British Columbia Ministry of Health. KCH is funded by the Canadian Institute of Health Research - Canada Graduate Scholarship. KU is funded by the Canada Research Chairs Program (#CRC-2019-00212). Funders had no role in the study design, data collection, analysis, or interpretation of the data, writing of the article or submission for publication. The authors thank the study participants for sharing their experiences, as well as researchers and staff. References BC Coroners Service. 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Kolla G, Pauly B, Cameron F, Hobbs H, Ranger C, McCall J, et al. If it wasn’t for them, I don’t think I would be here: experiences of the first year of a safer supply program during the dual public health emergencies of COVID-19 and the drug toxicity crisis. Harm Reduct J. 2024;21(1):111. Additional Declarations No competing interests reported. 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Over 13,000 people have since died as the crisis continues (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). In 2020, the BC government approved the Risk Mitigation Guidance (RMG) as a response to the dual public health emergencies of COVID-19 and an increasingly toxic drug supply. The RMG supported clinicians to prescribe alternatives to unregulated drugs, a form of prescribed safer supply (PSS) (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe toxic drug supply crisis has had devastating and intergenerational impacts on families and kinship networks. In the United States, an estimated 321,566 children lost a parent to overdose between 2011\u0026ndash;2021 (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Research shows that children of parents who use opioids often face a range of challenges, including disrupted parent-child relationships, lack of stable living conditions, and heightened vulnerability to grief and loss (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Parents who use drugs and have had their child apprehended experience a range of negative impacts, including a heightened risk of overdose, increased drug use, poorer mental health, and decreased motivation in treatment (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePrevious research has identified unique barriers and facilitators for mothers trying to access substance use services and treatment, with little research focusing on fathers and gender diverse parents (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Barriers parents experience include internalized stigma, substantiated concerns about (re)involvement of child welfare services or other punitive responses (e.g., forced treatment), judgement from service providers and family, fear of \u0026ldquo;failing\u0026rdquo; treatment, unwillingness to be separate from children and family during intensive treatment, transportation challenges, financial demands, time constraints, and limited availability of relevant services (\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Facilitators included motivations to be a good mother, having trusting relationships with service providers and family, assistance with transportation and childcare, collaborative care models, family-oriented programming, trauma-informed care, and parenting-specific supports (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). In Canada, while parental drug use itself is not considered a cause for child apprehension, this rationale is used frequently (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Parental barriers to care are influenced by social and structural determinants of health and compounded for those experiencing intersecting marginalized identities (e.g., Indigenous people, ethnic and sexual minorities) (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThere are significant gaps in research about experiences of parents trying to access support for unregulated substance use, particularly for medication-assisted interventions and populations beyond women in the perinatal period (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Indeed, given the extreme stigma associated with parenting and substance use and the over-surveillance of parents who use drugs by child welfare and healthcare services, parents remain a hidden population in substance use research. To address this gap, we undertook a study to explore differences in the experiences of parents and non-parents who accessed or tried to access a PSS under RMG. In this study, we refer to all people who have children as parents but recognize that not all individuals identify as parents or are actively parenting.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis study is part of a larger mixed methods evaluation of the implementation and impacts of the RMG in BC (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). The present study uses a mixed-methods design involving survey and interview data. Surveys were administered October 2020 through October 2021 primarily by phone or in-person in accordance with COVID-19 guidelines. Eligible participants were 19 or older, had used unregulated drugs in the past 6 months, and had received a safer supply prescription or were actively seeking one. We used SPSS version 30.0.0.0 (172) to run bivariate chi-square tests comparing experiences of parents and non-parents with PSS (including types and experiences with medications, barriers, and non-fatal overdoses).\u003c/p\u003e \u003cp\u003eWe conducted semi-structured interviews with a subset of survey participants (n\u0026thinsp;=\u0026thinsp;54). Participants were purposively sampled to ensure representation by gender, region, and prescription type. Parenting status was not specifically targeted. Interviews were recorded and transcribed verbatim. For this study, we used the survey item on parenting status to select interviews for analysis (n\u0026thinsp;=\u0026thinsp;16). Although our interview guide did not ask specific questions about parenting, we posed overarching questions about motivations, facilitators, barriers, and impacts related to PSS. Parenting-specific responses emerged to these questions in multiple interviews. We therefore conducted a thematic analysis of content related to parenting and having a child, (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) informed by the ecological model (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). The ecological model sensitized us to consider factors at the intrapersonal, interpersonal, organizational, community, and policy levels (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). This approach aligns with previous research identifying multi-level influences on parents\u0026rsquo; experiences of substance use services (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eStudy activities were approved by the University of Victoria Research Ethics Board (#20\u0026ndash;0293).\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eQuantitative Findings\u003c/h2\u003e \u003cp\u003eOf the 353 survey participants, 31.4% reported children under age 19 (see (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) for a comprehensive description of this survey sample). Half (50.5%) of parents and 62.2% of non-parents were men, 40.5% and 74.2% were white, and 57.5% and 52.7% were stably housed. Among parents, 9.0% reported having full-time care of their children and the majority (65.8%) reported children were living with family members. Most (68.5% of parents and 74.2% of non-parents) had accessed PSS.\u003c/p\u003e \u003cp\u003eNo significant differences were found between parents and non-parents in the ability to access desired medication, having a sufficient dosage to prevent withdrawal, or experiencing an overdose (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Many barriers were commonly reported by both parents and non-parents, including mistrust of healthcare providers, past negative interactions and feeling unsafe in clinics, beliefs that PSS will not be able to meet needs, lack of knowledge of where to access PSS, perceived costs, and concerns surrounding COVID-19. The only significant difference that emerged was that parents were more likely to report being too busy as a barrier to PSS compared to non-parents (41.4% vs. 25.4%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.003).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eExperiences of parents and non-parents of accessing or trying to access PSS\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-Parents\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eParents\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026#120594;\u0026sup2;\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;209)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;111)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReceived any prescription (n\u0026thinsp;=\u0026thinsp;320)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026#120594;\u0026sup2;(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;1.171, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.279\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54 (25.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35 (31.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e155 (74.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e76 (68.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType of prescription, n (%)\u003c/b\u003e\u003csup\u003e\u003cb\u003e1`\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOpioids\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e134 (64.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65 (58.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStimulants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42 (20.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (17.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBenzodiazepines\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (2.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo prescription\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54 (25.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35 (31.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAble to get desired Medication (n\u0026thinsp;=\u0026thinsp;227)\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026#120594;\u0026sup2;(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;1.368, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.242\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42 (27.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (20.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e111 (72.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59 (79.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDosage high enough for withdrawal (n\u0026thinsp;=\u0026thinsp;225)\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026#120594;\u0026sup2;(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;.549, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.459\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e92 (60.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47 (65.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e61 (39.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (34.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOverdose past two weeks (n\u0026thinsp;=\u0026thinsp;320)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026#120594;\u0026sup2;(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;.745, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.388\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e187 (91.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97 (88.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (8.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (11.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReported barriers\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCovid-19 Measures n\u0026thinsp;=\u0026thinsp;320\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026#120594;\u0026sup2;(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;2.154, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.142\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e127 (60.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58 (52.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e82 (39.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53 (47.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFear of, or past experiences of, stigma in health care (n\u0026thinsp;=\u0026thinsp;320)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026#120594;\u0026sup2;(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;.013, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.911\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e74 (35.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40 (36.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e135 (64.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71 (64.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSafety concerns when accessing health care (n\u0026thinsp;=\u0026thinsp;320)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026#120594;\u0026sup2;(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;1.259, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.262\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e126 (60.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e83 (39.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDesired PSS medication not available (n\u0026thinsp;=\u0026thinsp;320)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026#120594;\u0026sup2;(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) =. 204, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.651\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e94 (45.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47 (42.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e115 (55.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64 (57.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePrevious negative reaction from a health care provider (n\u0026thinsp;=\u0026thinsp;320)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026#120594;\u0026sup2;(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;.015, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.902\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e137 (65.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72 (64.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e72 (34.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39 (35.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLack of information about PSS (n\u0026thinsp;=\u0026thinsp;320)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026#120594;\u0026sup2;(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;1.504, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.220\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e153 (73.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56 (26.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePSS prescription Cost (n\u0026thinsp;=\u0026thinsp;320)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026#120594;\u0026sup2;(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;1.316, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.251\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e166 (79.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e94 (84.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43 (20.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (15.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBeing too Busy for PSS (n\u0026thinsp;=\u0026thinsp;320)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026#120594;\u0026sup2;(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;8.776, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e156 (74.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65 (58.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e53 (25.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46 (41.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHealth concerns (n\u0026thinsp;=\u0026thinsp;320)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026#120594;\u0026sup2;(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;.084, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.772\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e109 (52.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56 (50.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e100 (47.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55 (49.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDon\u0026rsquo;t think PSS will work (n\u0026thinsp;=\u0026thinsp;320)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026#120594;\u0026sup2;(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;1.004 \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.307\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e157 (75.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e89 (80.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52 (24.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (19.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMistrust of health care services (n\u0026thinsp;=\u0026thinsp;320)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026#120594;\u0026sup2;(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;.102, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.749\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e143 (68.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e66 (31.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLack of privacy in health care services (n\u0026thinsp;=\u0026thinsp;320)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026#120594;\u0026sup2;(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;1.502, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.220\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e160 (76.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78 (70.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49 (23.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33 (29.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003csup\u003e1\u003c/sup\u003eNot mutually exclusive (proportions do not sum to 100%)\u003c/p\u003e \u003cp\u003e\u003csup\u003e2\u003c/sup\u003eOnly respondents who reported having accessed PSS received this item\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e/ Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e here /\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eQualitative Findings\u003c/h3\u003e\n\u003cp\u003eInterviews were diverse with respect to gender, ethnicity, and housing stability. Two main ecological themes were identified: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) Parents have unique interpersonal motivations for accessing prescribed safer supply (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) Parents experience specific policy and regulatory barriers to accessing prescribed safer supply.\u003c/p\u003e\n\u003ch3\u003eParenting-specific interpersonal motivations in seeking PSS\u003c/h3\u003e\n\u003cp\u003eSome participants identified parenting-related motivations as reasons to pursue or stay on PSS. One motivation identified was improving the quality of the role parents had in their children\u0026rsquo;s lives: \u003cem\u003e\u0026ldquo;I\u0026rsquo;d like to get back to a point in my life where I can be a functioning part of my daughter\u0026rsquo;s life\u0026rdquo;\u003c/em\u003e (participant 3827). PSS was seen as a pathway to improve stability and therefore support more active engagement with their children.\u003c/p\u003e \u003cp\u003eAnother motivation was that PSS was viewed as providing separation and therefore protection from the toxicity of the street supply. Parents acknowledged that accessing the unregulated drug market could negatively impact their children: \u003cem\u003e\u0026ldquo;I don\u0026rsquo;t want to die over this. [\u0026hellip;] I don\u0026rsquo;t want to leave that legacy for my kids\u0026rdquo;\u003c/em\u003e (participant 2524) and expressed a need to have ways to avoid these harms. PSS was seen as one way to prevent harm, including children being exposed to a parent in withdrawal, \u003cem\u003e\u0026ldquo;I don\u0026rsquo;t ever want\u0026hellip; my son to see me sick. Ever\u0026rdquo;\u003c/em\u003e (participant 2565). Together, these quotes underline the intergenerational impacts of the toxic drug crisis and parents\u0026rsquo; motivation to protect their children from these harms.\u003c/p\u003e\n\u003ch3\u003eParenting-specific policy and regulatory barriers to PSS\u003c/h3\u003e\n\u003cp\u003e Some participants attributed barriers to parenting when trying to access or stay on PSS, however many barriers are the result of regulatory policies and procedures that exist within the current systems of care.\u003c/p\u003e \u003cp\u003eOne parent described fear that disclosing their substance use and accessing PSS would lead their healthcare provider to report them to child welfare services as unfit to parent. They linked fears to past negative experiences of being engaged in substance use treatment: \u0026ldquo;\u003cem\u003eI slipped and said I was on methadone to a social worker [\u0026hellip;] She kind of went from there and decided that she\u0026rsquo;d better open up a file [\u0026hellip;] it was just like \u0026lsquo;Really? Because I\u0026rsquo;m being honest? So what you want me to do is lie to you?\u0026rsquo; So that\u0026rsquo;s why I don\u0026rsquo;t trust anybody. I just have a hard time trusting anybody\u003c/em\u003e\u0026rdquo; (participant 2890), emphasizing how policy systems such as child welfare can create barriers.\u003c/p\u003e \u003cp\u003eParents also described the challenge of balancing work and family responsibilities with having their PSS medications dispensed daily at the pharmacy. This participant had their prescription cut off when: \u003cem\u003e\u0026ldquo;I was so busy working and family and stuff that I had missed two days [of dispensations]\u0026rdquo;\u003c/em\u003e (participant 2565), illustrating how a lack of attention and support to parents\u0026rsquo; competing commitments and dispensation regulations can act as a barrier to staying on PSS medications.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eFamilies across BC continue to be impacted by the toxic drug crisis. We found that parents experienced many policy barriers when trying to access PSS. In the survey, parents were more likely to report being too busy to access a prescription than non-parents. This was corroborated by interview findings that parenting responsibilities impeded participants\u0026rsquo; ability to access PSS and could result in discontinuation of prescriptions. Parenting-related time demands have likewise been identified as a barrier and potential factor for disengagement from care in existing research (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Other barriers parents reported included fears of drug use stigma from providers, the threat of child apprehension, and a lack of child-inclusive substance use services, highlighting the significant impact of current health and legal policies on parents who uses drugs. These barriers have also been reported by parents trying to access other substance use services such as treatment, underlining the need for systems-wide change (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e Notably, parents also had unique interpersonal motivations for pursuing PSS; namely, to take a more active role in their children\u0026rsquo;s lives and protect children from harm. This suggests addressing interpersonal factors, including parent-child relationships, may be an important consideration in PSS interventions. Non-stigmatizing care, respectful treatment, and the availability of wraparound services at PSS programs such as support in obtaining, social assistance and child tax benefits, childcare, housing, and food should be extended to family networks to reduce parenting-related barriers and support families (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFinally, we observed that men were more likely to report having a child under age 19 compared to women, yet the vast majority of research focuses on mothers who use drugs (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). The disregard of paternal needs in substance use and child welfare services is often overlooked, and this invisibility within services can further isolate fathers from children, fracture existing social networks, and prevent fathers from achieving their goals (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Our preliminary findings highlight a gap in the literature and more data are needed to explore the unique factors impacting fathers\u0026rsquo; access to safer supply and treatment.\u003c/p\u003e"},{"header":"Limitations","content":"\u003cp\u003eThe survey sample is limited by the non-random sampling approach that primarily relied on connecting with participants by phone, which may have resulted in an under sampling of those who were the most marginalized. Due to small sample size, we did not stratify parents based on custody status which may influence reported barriers. We were unable to report on the interview sample characteristics because of small sample sizes. The secondary analysis of qualitative data was valuable in highlighting that parenting has multiple intersections with PSS. However, these findings should be interpreted with caution as we did not include parenting-specific questions in our study instrument and thus we were limited to analyzing parenting-related experiences that were independently raised.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe intergenerational impact on families eight years into the toxic drug crisis continues. These findings highlight some of the challenges as well as motivations that parents who use drugs, including both fathers and mothers, experience when trying to access PSS and other substance use services. We recommend prioritizing parent-centered goals and echo calls for research, policy and programming that takes the entire family network into account (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research took place on the unceded territories of the\u0026nbsp;Lək̓ʷəŋən (Songhees and Xʷsepsəm/Esquimalt) and W̱S\u0026Aacute;NEĆ\u0026nbsp;Peoples\u0026nbsp;where the University of Victoria is located. Data were collected from the over 200 distinct First Nations in what is colonially known as British Columbia. This study was funded by Canadian Institutes of Health Research (#172 671), the Victoria Hospital Foundation and the British Columbia Ministry of Health. KCH is funded by the Canadian Institute of Health Research - Canada Graduate Scholarship. KU is funded by the Canada Research Chairs Program (#CRC-2019-00212). Funders had no role in the study design, data collection, analysis, or interpretation of the data, writing of the article or submission for publication. The authors thank the study participants for sharing their experiences, as well as researchers and staff.\u0026nbsp;\u003c/p\u003e\n"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBC Coroners Service. BC Coroners Service Death Review Panel: A Review of Illicit Drug Toxicity Deaths 2022 [Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www2.gov.bc.ca/assets/gov/birth-adoption-death-marriage-and-divorce/deaths/coroners-service/death-review-panel/review_of_illicit_drug_toxicity_deaths_2022.pdf\u003c/span\u003e\u003cspan address=\"https://www2.gov.bc.ca/assets/gov/birth-adoption-death-marriage-and-divorce/deaths/coroners-service/death-review-panel/review_of_illicit_drug_toxicity_deaths_2022.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBach P, Robinson S, Sutherland C, Brar R. Innovative strategies to support physical distancing among individuals with active addiction. Lancet Psychiatry. 2020;7(9):731\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJones CM, Zhang K, Han B, Guy GP, Losby J, Einstein EB, et al. Estimated Number of Children Who Lost a Parent to Drug Overdose in the US From 2011 to 2021. JAMA Psychiatry. 2024;81(8):789\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVoss MW, Barrett TS, Campbell AJ, Van Komen A. Parenting and the opioid epidemic: A systematic scoping review. J Child Fam stud. 2023;32(5):1280\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSmith JC, Alderman L, Attell BK, Avila Rodriguez W, Covington J, Manteuffel B, et al. Dynamics of Parental Opioid Use and Children's Health and Well-Being: An Integrative Systems Mapping Approach. Front Psychol. 2021;12:687641.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDarlington CK, Clark R, Jacoby SF, Terplan M, Alexander K, Compton P. Outcomes and experiences after child custody loss among mothers who use drugs: A mixed studies systematic review. Drug Alcohol Depend. 2023;251:110944.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBarnett ER, Knight E, Herman RJ, Amarakaran K, Jankowski MK. Difficult binds: A systematic review of facilitators and barriers to treatment among mothers with substance use disorders. J Subst Abuse Treat. 2021;126:108341.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBoyd J, Maher L, Austin T, Lavalley J, Kerr T, McNeil R. Mothers Who Use Drugs: Closing the Gaps in Harm Reduction Response Amidst the Dual Epidemics of Overdose and Violence in a Canadian Urban Setting. Am J Public Health. 2022;112(S2):S191\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWolfson L, Schmidt RA, Stinson J, Poole N. Examining barriers to harm reduction and child welfare services for pregnant women and mothers who use substances using a stigma action framework. Health Soc Care Commun. 2021;29(3):589\u0026ndash;601.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNosyk B, Slaunwhite A, Urbanoski K, Hongdilokkul N, Palis H, Lock K, et al. Evaluation of risk mitigation measures for people with substance use disorders to address the dual public health crises of COVID-19 and overdose in British Columbia: a mixed-method study protocol. BMJ open. 2021;11(6):e048353.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBraun V, Clarke V. Using thematic analysis in psychology. Qualitative Res Psychol. 2006;3(2):77\u0026ndash;101.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcLeroy KR, Bibeau D, Steckler A, Glanz K. An Ecological Perspective on Health Promotion Programs. Health Educ Q. 1988;15(4):351\u0026ndash;77.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUrbanoski KA, van Roode T, Selfridge M, Hogan KC, Fraser J, Lock K et al. Access and barriers to safer supply prescribing during a toxic drug emergency: a mixed methods study of implementation in British Columbia, Canada. Substance Abuse Treatment, Prevention, and Policy. 2024;19(1):44.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWilliams IL. Desilencing Fatherhood: Making the Invisible Visible Within Substance Use Disorder Treatment. J Groups Addict Recovery. 2014;9(2):160\u0026ndash;85.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKolla G, Pauly B, Cameron F, Hobbs H, Ranger C, McCall J, et al. If it wasn\u0026rsquo;t for them, I don\u0026rsquo;t think I would be here: experiences of the first year of a safer supply program during the dual public health emergencies of COVID-19 and the drug toxicity crisis. Harm Reduct J. 2024;21(1):111.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"harm-reduction-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"harj","sideBox":"Learn more about [Harm Reduction Journal](http://harmreductionjournal.biomedcentral.com/)","snPcode":"12954","submissionUrl":"https://submission.nature.com/new-submission/12954/3","title":"Harm Reduction Journal","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Prescribed Safer Supply, Parenting, Harm Reduction, Substance use, child welfare system, British Columbia, Canada","lastPublishedDoi":"10.21203/rs.3.rs-7820725/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7820725/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjectives\u003c/h2\u003e \u003cp\u003eIn 2020, British Columbia implemented prescribed safer supply (PSS) to reduce harms associated with the toxic drug supply. Evidence is emerging on these programs; however, no studies to date have focused on exploring the experiences of parents accessing or attempting to access PSS, including differences between parents and non-parents in reported barriers.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis mixed-methods study used data from a cross-sectional survey (n\u0026thinsp;=\u0026thinsp;353) with people who had received or were seeking PSS recruited between October 2020\u0026ndash;2021. Semi-structured interviews were completed with a subset of survey respondents (n\u0026thinsp;=\u0026thinsp;16) who reported having children under age 19. We conducted a descriptive analysis of survey data on barriers to care, and a secondary thematic analysis of interviews on parents\u0026rsquo; experiences of PSS informed by an ecological model.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAmong 353 recruited, 31.4% of participants reported having a child under age 19. All participants reported barriers to PSS; however, parents were more likely to report being too busy compared to non-parents (41.4% vs. 25.4%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.003). Ecological themes describing parents\u0026rsquo; experiences of PSS reflected: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) unique interpersonal motivations for accessing PSS, such as to participate in children\u0026rsquo;s lives and protect them from potential harms and (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) parenting-associated policy barriers, including fear child welfare reports and competing time demands.\u003c/p\u003e\u003ch2\u003eDiscussion\u003c/h2\u003e \u003cp\u003e Parents reported unique interpersonal motivations and policy challenges when accessing PSS. These findings highlight the need to address stigmatizing, punitive responses to families experiencing substance use and support approaches that are parent-centered and inclusive of the family across a continuum of care.\u003c/p\u003e","manuscriptTitle":"The characteristics and experiences of parents accessing prescribed safer supply in BC, 2020-2021","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-09 12:10:06","doi":"10.21203/rs.3.rs-7820725/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-18T19:33:32+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-12T03:00:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"260104474520287268378124094899450945944","date":"2026-02-02T20:15:48+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-20T17:51:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"282701414595172469025869883509657904473","date":"2026-01-07T20:24:52+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-07T19:52:49+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-14T09:42:02+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-14T09:40:51+00:00","index":"","fulltext":""},{"type":"submitted","content":"Harm Reduction Journal","date":"2025-10-09T19:59:25+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"harm-reduction-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"harj","sideBox":"Learn more about [Harm Reduction Journal](http://harmreductionjournal.biomedcentral.com/)","snPcode":"12954","submissionUrl":"https://submission.nature.com/new-submission/12954/3","title":"Harm Reduction Journal","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0a862820-58fb-4fc9-9106-438db69e7321","owner":[],"postedDate":"January 9th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-29T18:38:23+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-09 12:10:06","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7820725","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7820725","identity":"rs-7820725","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}