Taming systems to create enabling environments for HCV treatment: Negotiating trust in the drug and alcohol setting

► Mistrust in the health care system, particularly the hospital setting, is a barrier to HCV treatment uptake among PWID. ► London health care providers facilitated the trust and engagement of PWID by modifying elements of the HCV treatment system. ► Providers' perceived drug and alcohol services as more amenable to modification or 'taming' than the hospital setting. ► 'Negotiated flexibility' was enacted in regard to appointments, eligibility, substance use and phlebotomy. ► Our findings problematise a common conceptual demarcation between trust and dependency.