Challenges of implementing safer supply programs in Canada during the COVID-19 pandemic: A qualitative analysis

The influence of transformations in supply on methamphetamine initiation among people injecting opioids in the United States

“…Alternative models of supply through state monopolies, as with alcohol, or nationalized health service programs with heroin and other opioids, could reduce harms as they lack the market incentives to expand consumption and can control product quality [ 90 , 91 ]. A number of countries, including Canada and Switzerland, have prescribed opioids to dependent patients using varied models of medical prescription and contrasting goals, whether as a form of treatment, harm reduction or, in England during the late 1960s, to both treat individuals and control the wider drug supply [ 91 – 93 ]. They have shown proven effectiveness in improving individual health while their potential for attracting patients away from other suppliers can be influenced by the nature of the wider drug market, prescribed dose levels and the degree of autonomy afforded to participants [ 94 , 95 ].…”

Prescribed safer supply during dual public health emergencies: a qualitative study examining service providers perspectives on early implementation

“…In a review of Canada’s safer supply programs [ 52 ], reported issues related to program capacity, medicalization, challenges related to addressing health inequities and limited organizational resources. Innovations in the SAFER program were designed to remove barriers to access through an interdisciplinary team supporting participants to access safer supply alongside other health and social supports.…”

“And this is the life jacket, the lifeline they’ve been wanting”: Participant perspectives on navigating challenges and successes of prescribed safer supply

“…When looking at challenges, prescribed SSPs in Ontario are overly medicalized [33] with guidelines requiring participants to make frequent clinic visits for prescriptions [24,34], participate in urine drug screening [16,35], and go to the pharmacy daily for both witnessed long-acting medication ingestion [16,24,35] and immediate-release medication pick-up [34,36]. While some participants were accepting of these requirements, the medicalization of SSPs is reported to be a barrier to attraction for PWUD due to their general mistrust in the health care system, based on decades of criminalization and stigmatization [17,33]. Some participants reported that the structure prevented them from living their lives, accessing paid work, and visiting out of town family and friends.…”

“…These contrasting experiences with medicalization and structure point to the need to implement alternative, innovative models of safer supply that would allow participants to have agency and autonomy over their lives. This could include looking at options for non-prescribed safer supply models, such as compassion clubs, where participants can access their safer supply without needing a prescription [28,33,[35][36][37][38].…”

“…What is ultimately needed is easy and equitable access to a safer supply [14,45]. There are challenges to scaling up prescribed SSPs as they exist today to serve all PWUD due to issues such as operational costs, staff shortages, structural inequities, limited access to desired medications, and overmedicalization of services [33]. This speaks to the need for a variety of SSP models, prescribed and non-prescribed, to reach everyone who needs it.…”