“COVID just kind of opened a can of whoop-ass”: The rapid growth of safer supply prescribing during the pandemic documented through an environmental scan of addiction and harm reduction services in Canada

Glegg, Stephanie; McCrae, Karen; Kolla, Gillian; Touesnard, Natasha; Turnbull, Jeffrey; Brothers, Thomas D.; Brar, Rupinder; Sutherland, Cindy; Foll, Bernard Le; Sereda, Andrea; Goyer, Marie-Ève; Rai, Nanky; Scott, Bernstein; Fairbairn, Nadia

doi:10.1016/j.drugpo.2022.103742

Cited by 43 publications

(51 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Perhaps, the most notable change in this category is reflected by the number of sites that provided safer supply across Canada, which expanded by 60 between March 1 and May 1, 2020 (21 to 81). Participants reported recognizing the heightened risks their clients faced from the increasingly toxic drug supply and the lack of supports available to PWUD as a consequence of public health restrictions [ 10 ]. Strategies such as increasing medication dosages and expanding the range of available medications became paramount for addressing overdose risk after urgent COVID-19-targeted actions to reduce risk were implemented.…”

Section: Resultsmentioning

confidence: 99%

“…These flexible participation options were provided in order to reduce respondent burden in the context of the pandemic. The methods are described in more detail elsewhere [ 10 ].…”

Section: Methodsmentioning

confidence: 99%

“…Given the rapidly changing landscape and lack of available data to guide public health decision-making in the context of dual public health emergencies, the scope of the national environmental scan was expanded to document changes that participating sites made between March 1 and May 1, 2020, and to include sites newly engaged in safer supply prescribing. In Canada, iOAT, TiOAT, and safer supply are currently provided at: (1) comprehensive and dedicated programs in stand-alone facilities or acute care centers, (2) facilities embedded within existing community health clinics, harm reduction programs, and housing programs (note that safer supply is offered in a more diverse range of settings than iOAT and TiOAT, including youth and mental health services and perinatal care, among others [ 10 ]), (3) pharmacy-based sites, whereby services are provided in existing clinics with supervision of administration provided by trained pharmacists at select pharmacy locations, and (4) select hospitals, whereby treatment is initiated in hospital with transfer to community-based prescribers at discharge [ 11 , 12 ]. Safer supply may also be accessed via healthcare practitioners who prescribe it as part of their regular medical practice [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

“…The purpose of the current subset of the environmental scan’s analysis was to identify the service delivery changes implemented by sites offering pharmaceutical alternatives (i.e., iOAT, TiOAT, safer supply) in Canada, early on in the COVID-19 pandemic. While the dramatic 285% increase in the number of sites offering safer supply between March 1 and May 1, 2020 is described in detail elsewhere [ 10 ], this article is focused on adjustments to staffing, ancillary services, program operations, use of physical space, and client protocols. This analysis will be of particular interest to policy makers and public health officials, prescribers, and other healthcare providers to inform the nature and impact of COVID-19 responses on addiction care and harm reduction service implementation.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

The changing landscape of pharmaceutical alternatives to the unregulated drug supply during COVID-19

et al. 2022

Self Cite

View full text Add to dashboard Cite

Background The dual COVID-19 and overdose emergencies amplified strain on healthcare systems tasked with responding to both. One downstream consequence of the pandemic in the USA and Canada was a surge in drug overdoses resulting from public health-restricted access to services and an increasingly toxic unregulated drug supply. This study aimed to describe changes implemented by programs prescribing pharmaceutical alternatives to the drug supply during the early stages of the COVID-19 pandemic. Methods An environmental scan used surveys and qualitative interviews with service providers across Canada to examine pharmaceutical alternative prescribing practices and programs before and during the pandemic. This study summarized the nature, frequency, and reasons for pandemic-driven service delivery changes using directed content analysis, counts, and thematic analysis. Results Eighty-two of the 103 participating sites reported 1193 unique changes in physical space (368), client protocols (347), program operations (342), ancillary services (127), and staffing (90). Four qualitative themes describing the reasons for these changes emerged, namely (1) decreasing risk of COVID-19 infection; (2) decreasing risk of overdose; (3) prioritizing acute care of COVID-19 patients; and (4) improving client access to treatment. Conclusions While most changes were aimed at decreasing risk of COVID-19 infection, some were found to be at odds with the measures needed to combat the overdose crisis; others met dual objectives of decreased risk of both overdose and infection. Further research should examine which changes should be kept or reversed once COVID-19-related public health measures are lifted.

show abstract

Section: Resultsmentioning

confidence: 99%

“…These flexible participation options were provided in order to reduce respondent burden in the context of the pandemic. The methods are described in more detail elsewhere [ 10 ].…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The changing landscape of pharmaceutical alternatives to the unregulated drug supply during COVID-19

et al. 2022

Self Cite

View full text Add to dashboard Cite

show abstract

“…To date, minimal literature has directly explored professional stakeholder perspectives on safer supply approaches [ 30 ] or the varied ways in which safer supply is conceptualized both in design and implementation. Therefore, we undertook this study to explore stakeholder perspectives on key features of safer supply, support for and reservations about this approach, facilitators and barriers to implementation, and visions of ideal safer supply interventions.…”

Section: Introductionmentioning

confidence: 99%

Moving towards a continuum of safer supply options for people who use drugs: A qualitative study exploring national perspectives on safer supply among professional stakeholders in Canada

Foreman-Mackey

Pauly

Ivsins

et al. 2022

Subst Abuse Treat Prev Policy

View full text Add to dashboard Cite

Background Novel public health interventions are needed to address the toxic drug supply and meet the needs of people who use drugs amidst the overdose crisis. Safer supply – low-barrier distribution of pharmaceutical grade substances – has been implemented in some jurisdictions to provide safer alternatives to the unregulated drug supply, yet no studies to date have explored professional stakeholder perspectives on this approach. Methods We used purposive sampling to recruit professional stakeholders (n = 17) from four locations in British Columbia, Ontario, and Nova Scotia, including program managers, executive directors, political and health authority representatives, and healthcare providers involved in the design, implementation, and/or operation of safer supply programs in their communities. Semi-structured, one-to-one interviews were conducted, and interview data were coded and analyzed using thematic analyses. Results Participants defined safer supply as low-barrier access to substances of known quality and quantity, offered on a continuum from prescribed to a legal, regulated supply, and focused on upholding autonomy and liberation of people who use drugs. Stakeholders expressed support for safer supply but explained that current iterations do not meet the needs of all people who use drugs and that implementation is limited by a lack of willing prescribers, stigma towards people who use drugs, and precarity of harm reduction programs to political ideology. Stakeholders expressed strong support for wider-reaching approaches such as decriminalization, legalization, and regulation of substances as a way to fully realize a continuum of safer supply, directly address the overdose crisis and toxic drug supply, and ensure equity of access nationally. Conclusion The results of this study highlight the need for innovative strategies to address the overdose crisis and that safer supply has the potential to benefit certain people who use drugs. A one-size-fits-all approach is not sufficient and the perspectives of professional stakeholders should be considered alongside those of people who use drugs when designing and implementing future safer supply.

show abstract

A Preliminary Assessment of Short-Term Social and Substance Use-Related Outcomes Among Clients of Integrated Safer Opioid Supply Pilot Programs in Toronto, Canada

Nafeh,

Mbichila,

Bouck

et al. 2023

Int J Ment Health Addiction

View full text Add to dashboard Cite

Canada is experiencing an ongoing overdose crisis, driven by a toxic unregulated drug supply. Integrated safer supply pilot programs offer pharmaceutical alternatives, coupled with comprehensive support services, to individuals using unregulated drug supply who are at high risk of overdose. We collected data from December 2020 to January 2023 on clients receiving safer opioid supply from five frontline service providers in Toronto, Canada, using interviewer-administered questionnaires. We assessed the incidence rate ratio of self-reported overdose comparing pre- and post-enrolment in the programs and examined changes in the prevalence of social and substance use outcomes post-enrolment. Forty-one participants were recruited, of whom 26 were followed up for a median of eight months (interquartile range, 5.0–11.7). The incidence rate ratio of overdose comparing post-enrolment to pre-enrolment was 0.20 (95% confidence interval, 0.09–0.43). Participants reported several positive social and substance use outcomes at follow-up, including a reduction in reliance on the unregulated supply and reduced criminal activity. Future implementation of integrated safer opioid supply pilot programs with larger sample sizes and rigorous epidemiological designs could help further illustrate the potential impacts of these programs in reducing overdose rates in Canada.

show abstract

“COVID just kind of opened a can of whoop-ass”: The rapid growth of safer supply prescribing during the pandemic documented through an environmental scan of addiction and harm reduction services in Canada

Cited by 43 publications

References 16 publications

The changing landscape of pharmaceutical alternatives to the unregulated drug supply during COVID-19

The changing landscape of pharmaceutical alternatives to the unregulated drug supply during COVID-19

Moving towards a continuum of safer supply options for people who use drugs: A qualitative study exploring national perspectives on safer supply among professional stakeholders in Canada

A Preliminary Assessment of Short-Term Social and Substance Use-Related Outcomes Among Clients of Integrated Safer Opioid Supply Pilot Programs in Toronto, Canada

Contact Info

Product

Resources

About