Precarity and opioid use: a narrative review on the low threshold approach
Introduction: People in situation of precariousness and using opioids face several barriers to health and social care services. Low threshold resources aiming to reduce these barriers were created. However, there is some discrepancy when describing their goals and definition. This article seeks to identify core characteristics of low threshold services targeting people in situation of precariousness and using opioids. Methods: We conducted a narrative literature review, following three themes: (1) the philosophy of intervention underlying the low threshold approach; (2) the specific services and interventions that need to be offered; (3) services organization and management of these resources. We included 47 articles for analysis. Results: The analysis related to the philosophy of intervention highlighted several observations regarding the upmost consideration given to the person and the overall care and support environment. The second theme described the diversity of interventions to offer in order to answer appropriately to these persons needs and objectives, involving for instance primary care and specialized resources. The last topic emphasized considerations regarding the organization and management of these services. For example, we described the stakeholders’ teams composition and functioning, the resources and services integration in a continuum where collaboration, mobility and the reference processes are crucial. We also noted the importance of both care and support environments and services’ internal regulations. Conclusion: This review highlighted key elements defining the low threshold approach. We also suggested that these core characteristics could be useful when considering every health and social services. This would contribute to the overall accessibility and quality of resources targeting people using psychoactive substances and associated issues.