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

Abstract

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.

British Columbia’s Safer Opioid Supply Policy and Opioid Outcomes

“…The increase in prescription rates without a significant increase in prescriber rates suggests that a small number of prescribers contributed to the increased prescriptions. While this might reflect hesitancy among physicians to participate in the Safer Opioid Supply policy program 9 , 31 and possible frequent prescriptions of small opioid amounts, it is important to ensure that safer supply opioids are prescribed to and used by people who use drugs and are targeted by the policy. In particular, given some reports of diversion of safer supply opioids, measures to address such diversion (eg, witnessing ingestion or injection of the drug by a health professional 32 ) are needed.…”

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

“…This pilot SSP is a nurse practitioner-led program that was developed based on extensive consultation with the local community of PWUD. Including PWUD in all aspects of SSP development, from design to implementation to evaluation, is crucial to the effective delivery of care [14,[22][23][24]. The process of holding interviews, focus groups, and advisory committee meetings led to the development of a SSP that, where possible, exists by and for the community of PWUD.…”

“…From this, the SSPs that are currently being funded by Health Canada are a medicalized, prescriber-based adaptation of this concept. These prescribed SSPs are rooted in harm reduction philosophy and provide participants who are at the highest risk of unregulated drugrelated harms with pharmaceutical-grade medications of known quality and composition to replace the unpredictable and toxic street supply of drugs [13][14][15][16].…”

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

“…A previous study of professional stakeholders (i.e., program managers, health authority representatives) involved in the implementation of safer supply across Canada identified low-barrier models and participation in a community of prescribers as facilitators. Potential barriers included concerns about the temporary nature of programs, emphasis on treatment rather than harm reduction, lack of support from regulatory colleges, and the ongoing context of criminalization [ 19 ]. We contribute to this literature by exploring early implementation from the perspectives of an interdisciplinary team of service providers during the first year of implementation of one community-based prescribed safer supply program to provide in-depth insights related to program development.…”