A low-barrier, flexible safe supply program to prevent deaths from overdose

Klaire, Sukhpreet; Sutherland, Cindy; Kennedy, Mary Clare

doi:10.1503/cmaj.211515

Cited by 22 publications

(28 citation statements)

References 8 publications

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“…An overhaul of the regulatory environment for OAT in Australia could support person-centred care, but there is also a need for a cultural shift that centres the treatment goals of the person receiving OAT. Reform of OAT provision could draw on the experiences of sites in other countries which report GP-based treatment for OAT ( Benyamina, 2014 ), provide a large number of takeaways ( Trujols et al, 2020 ), or offer other medication options such as hydromorphone ( Klaire et al, 2022 May 16 ). Despite being listed on Australia's Pharmaceutical Benefits Scheme (which includes medicines that are available to be dispensed to patients at a Government-subsidised price), OAT in community pharmacies in Australia is different to other medicines in that it is subject to uncapped dispensing fees which exacerbated financial stress for many study participants.…”

Section: Discussionmentioning

confidence: 99%

“You'll come in and dose even in a global pandemic”: A qualitative study of adaptive opioid agonist treatment provision during the COVID-19 pandemic

Conway¹,

Treloar²,

Crawford³

et al. 2023

International Journal of Drug Policy

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Section: Discussionmentioning

confidence: 99%

“You'll come in and dose even in a global pandemic”: A qualitative study of adaptive opioid agonist treatment provision during the COVID-19 pandemic

Conway¹,

Treloar²,

Crawford³

et al. 2023

International Journal of Drug Policy

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“…A key motivation for our review was to identify potential opportunities to reduce risks for injecting-related bacterial and fungal infec- OAT is associated with low risk for bacterial infections even when injected intramuscularly, as sterile, liquid formulations of drugs are provided in a hygienic and safe environment [103]. Prescribed safer supply programmes involve health professionals providing pharmaceutical-grade alternatives to unregulated drugs [104][105][106][107].…”

Section: Discussionmentioning

confidence: 99%

“…Injectable OAT is associated with low risk for bacterial infections even when injected intramuscularly, as sterile, liquid formulations of drugs are provided in a hygienic and safe environment [103]. Prescribed safer supply programmes involve health professionals providing pharmaceutical‐grade alternatives to unregulated drugs [104–107]. Patients/clients can take these home and consume them how they prefer (including crushing and injecting tablets) and/or consume under supervision (depending on the programme).…”

Section: Discussionmentioning

confidence: 99%

Social and structural determinants of injection drug use‐associated bacterial and fungal infections: A qualitative systematic review and thematic synthesis

Brothers

Bonn²,

Lewer

et al. 2023

Addiction

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Background and aimsInjection drug use‐associated bacterial and fungal infections are increasingly common, and social contexts shape individuals’ injecting practices and treatment experiences. We sought to synthesize qualitative studies of social–structural factors influencing incidence and treatment of injecting‐related infections.MethodsWe searched PubMed, EMBASE, Scopus, CINAHL and PsycINFO from 1 January 2000 to 18 February 2021. Informed by Rhodes’ ‘risk environment’ framework, we performed thematic synthesis in three stages: (1) line‐by‐line coding; (2) organizing codes into descriptive themes, reflecting interpretations of study authors; and (3) consolidating descriptive themes into conceptual categories to identify higher‐order analytical themes.ResultsWe screened 4841 abstracts and included 26 qualitative studies on experiences of injecting‐related bacterial and fungal infections. We identified six descriptive themes organized into two analytical themes. The first analytical theme, social production of risk, considered macro‐environmental influences. Four descriptive themes highlighted pathways through which this occurs: (1) unregulated drug supply, leading to poor drug quality and solubility; (2) unsafe spaces, influenced by policing practices and insecure housing; (3) health‐care policies and practices, leading to negative experiences that discourage access to care; and (4) restrictions on harm reduction programmes, including structural barriers to effective service provision. The second analytical theme, practices of care among people who use drugs, addressed protective strategies that people employ within infection risk environments. Associated descriptive themes were: (5) mutual care, including assisted‐injecting and sharing sterile equipment; and (6) self‐care, including vein health and self‐treatment. Within constraining risk environments, some protective strategies for bacterial infections precipitated other health risks (e.g. HIV transmission).ConclusionsInjecting‐related bacterial and fungal infections are shaped by modifiable social–structural factors, including poor quality unregulated drugs, criminalization and policing enforcement, insufficient housing, limited harm reduction services and harmful health‐care practices. People who inject drugs navigate these barriers while attempting to protect themselves and their community.

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“…In 2021, a safe supply project in Victoria, BC received four million dollars to operate over the next three years. This project, SAFER, which has two locations, one in Vancouver and the other in Victoria facilitates access to more progressive prescribed pharmaceuticals such as fentanyl, sub-lingual fentanyl, and fentanyl patches as an alternative to the contaminated unregulated drug supply [ 42 , 43 ]. In contrast, smaller or more rural areas such as the Atlantic Region (NS, New Brunswick, Prince Edward Island, Newfoundland) only offer safe supply via a prescriber and their patient on a case-by-case basis, without formal support from the College of Physicians and Surgeons.…”

Section: Discussionmentioning

confidence: 99%

“…Critics of safe supply most often highlight the risk of diversion, which can be described as any non-intended or non-medical use of a prescribed medication, or use by any individual other than for whom it was prescribed. Another concern among critics is that providing substances legally could perpetuate substance use and undermine treatment options such as OAT [ 23 ]. Of note, safe supply can be distinguished from OAT (methadone, buprenorphine, slow-release oral morphine) by their overarching goals.…”

Section: Introductionmentioning

confidence: 99%

’More of the same, but worse than before’: A qualitative study of the challenges encountered by people who use drugs in Nova Scotia, Canada during COVID-19

Comeau

Bonn²,

Wildeman

et al. 2023

PLoS ONE

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Background To learn about the experiences of people who use drugs, specifically opioids, in the Halifax Regional Municipality (HRM), in Nova Scotia, Canada during the COVID-19 pandemic through qualitative interviews with people who use drugs and healthcare providers (HCP). This study took place within the HRM, a municipality of 448,500 people [1]. During the pandemic many critical services were interrupted while overdose events increased. We wanted to understand the experiences of people who use drugs as well as their HCPs during the first year of the pandemic. Methodology We conducted a qualitative study using semi-structured interviews with 13 people who use drugs and 6 HCPs, including physicians who work in addiction medicine (3), a pharmacist, a nurse, and a community-based opioid agonist therapy (OAT) program staff member. Participants were recruited within HRM. Interviews were held via phone or videoconference due to social distancing directives. Interviews focused on the challenges people who use drugs and HCPs faced during the pandemic as well as elicited perspectives on a safe supply of drugs and the associated barriers and facilitators to the provision of a safe supply. Results Of the 13 people who use drugs who participated in this study, ages ranged from 21–55 years (mean 40). Individuals had spent on average 17 years in HRM. Most people who use drugs (85%, n = 11) utilized income assistance, the Canadian Emergency Response Benefit, or disability support. Many had experienced homelessness (85%, n = 11) and almost half (46%, n = 6) were currently precariously housed in the shelter system. The main themes among interviews (people who use drugs and HCPs) were housing, accessing healthcare and community services, shifts in the drug supply, and perspectives on safe supply. Conclusions We identified several challenges that people who use drugs face in general, but especially during the COVID-19 pandemic. Access to services, housing support, and interventions to use safely at home were limited. As many challenges faced by people who use drugs exist outside of COVID-19, we concluded that the formal and informal interventions and changes in practice that were made to support people who use drugs should be sustained well past the end of the pandemic. The need for enhanced community supports and a safe supply of drugs, despite its complicated nature, is essential for the health and safety of people who use drugs in HRM, especially during COVID-19.

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A low-barrier, flexible safe supply program to prevent deaths from overdose

Cited by 22 publications

References 8 publications

“You'll come in and dose even in a global pandemic”: A qualitative study of adaptive opioid agonist treatment provision during the COVID-19 pandemic

“You'll come in and dose even in a global pandemic”: A qualitative study of adaptive opioid agonist treatment provision during the COVID-19 pandemic

Social and structural determinants of injection drug use‐associated bacterial and fungal infections: A qualitative systematic review and thematic synthesis

’More of the same, but worse than before’: A qualitative study of the challenges encountered by people who use drugs in Nova Scotia, Canada during COVID-19

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