Community partner perspectives on the implementation of a novel safer supply program in Canada: a qualitative study of the MySafe Project

Abstract

Background The adulteration of the illicit drug supply with fentanyl and its analogues is driving the ongoing overdose crisis in North America. While various harm reduction interventions address overdose-related risks, there is growing interest in safer supply programs, including the MySafe Project which utilizes a biometric dispensing machine that provides pharmaceutical opioid alternatives to the toxic drug supply. However, the experiences and perspectives of professional community partners on program implementation remain unexplored. This study aims to examine professional community partner perspectives on the feasibility, as well as barriers and facilitators to the implementation of the MySafe program. Methods Semi-structured qualitative interviews were conducted with 17 professional community partners involved in program implementation across four pilot locations in Canada. Thematic analysis of interviews focused on perspectives on safer supply, barriers and facilitators faced during program implementation, and recommendations to inform future scale-up of low-barrier safer supply models across Canada. Results Participants identified a variety of barriers, including the dependence on clinician buy-in, coupled with regulatory and logistical constraints. In addition, some participants perceived hydromorphone to be an inadequate substitute to the increasingly toxic street opioid supply. Lastly, technical difficulties were described as barriers to service uptake and delivery. Conversely, having political and community buy-in, availability of wrap-around services, and collaborative communication from the MySafe team served as facilitators to program implementation. Though community partners preferred establishing MySafe machines into existing community organizations, they also discussed benefits of housing-based MySafe programs. The potential role of this program in mid-sized to rural cities was also emphasized. Conclusions To address the overdose crisis, there is an urgent need to implement and evaluate novel solutions that address supply drivers of crisis. Community partner-informed research plays an integral role in ensuring program acceptability and proper implementation. Our findings identify current gaps and facilitators underlying the efficacy of one such model, together with future directions for improvement. Participant recommendations included a diversification of medications offered and types of locations for MySafe programs, a streamlined national approach to prescribing guidelines coupled with more robust training for healthcare professionals, and an emphasis on service delivery within an integrated services model. Our findings underscore a potential gap between the goals of healthcare providers in ensuring comprehensive care and the necessity for low-barrier models such as MySafe that can function both within and outside of integrated service models.

British Columbia’s Safer Opioid Supply Policy and Opioid Outcomes

“…There is little evidence on the impacts of safer supply programs to inform this debate. Some qualitative studies suggest that safer supply programs positively impacted the lives of participants and were associated with reduced overdose risks, although participants highlighted inadequate substitutability of hydromorphone for unregulated opioids . Three quantitative studies found that the programs were associated with lower risk of nonfatal overdose .…”

“…Some qualitative studies suggest that safer supply programs positively impacted the lives of participants 13 and were associated with reduced overdose risks, 14 , 15 although participants highlighted inadequate substitutability of hydromorphone for unregulated opioids. 16 Three quantitative studies found that the programs were associated with lower risk of nonfatal overdose. 17 , 18 , 19 However, these studies looked at only small-scale programs adopted in specific community settings (COVID-19 isolation shelters and primary health care centers) in Nova Scotia and Ontario, lacked control groups 17 , 18 or had a control group that was not comparable with the treated group, 19 and did not satisfactorily account for other concurrent interventions and policies.…”