Safer supply

Safer supply refers to providing prescribed medications as a safer alternative to the toxic illegal drug supply to people who are at high risk of overdose. Safer supply services can help prevent overdoses, save lives, and connect people who use drugs to other health and social services.

On this page:

• The role of safer supply in addressing Canada's drug overdose crisis
• About safer supply services
• Where to access safer supply services
• Who can access safer supply services
• The difference between safer supply and opioid agonist treatment
• The benefits of safer supply
• How we are supporting safer supply

The role of safer supply in addressing Canada's drug overdose crisis

The drug overdose crisis continues to have devastating impacts on Canadian communities and families. The illegal drug supply contains strong opioids, such as fentanyl, and other toxic substances causing high rates of overdoses and deaths. The COVID-19 pandemic has also contributed to the worsening overdose crisis, with some communities reporting record high numbers of overdose deaths, hospitalizations, and emergency medical service calls.

Safer supply services provide an alternative to the toxic illegal drug supply as a way to help prevent overdoses and can connect people to other health and social services.

About safer supply services

Safer supply services provide prescribed medications to people who use drugs, overseen by a health care practitioner, with the goal of preventing overdoses and saving lives. They are provided in a less clinical and more flexible way compared to other care options for substance use, such as opioid agonist treatment (OAT). For example, safer supply services may offer:

• a range of medication options
• accessible locations (for example, services available at a community health centre)
• flexible eligibility requirements
• flexible dosing conditions and carrying rules (for example, clients may be able to pick up their supply and use as needed)
• flexible client goals (for example, focusing on improving health and not requiring that clients stop using illegal drugs)

These services are intended to reach people at risk of overdose for whom currently available care options have been ineffective or inappropriate.

At the discretion of health care practitioners, the medications prescribed by safer supply services may include:

• opioid medications
• stimulant medications
• benzodiazepines

In some cases, safer supply services include providing or connecting people with other health and social services, where possible and appropriate, such as:

• general medical care, including substance use disorder treatment programs
• mental health counseling
• supports for any other health conditions, such as HIV/AIDS and Hepatitis C
• employment supports
• housing supports

Where to access safer supply services

There are a number of safer supply service locations in Canada. Some receive funding from larger initiatives such as our Substance Use and Addictions Program (SUAP). A list of safer supply projects funded by SUAP is available on the interactive map summarizing Canada's response to the overdose crisis.

Settings where safer supply services operate may include:

• medical clinics
• supportive housing
• community pharmacies
• community health centres
• supervised consumption sites

Some health care practitioners are starting to prescribe safer supply as part of their regular medical practice. Safer supply is one of many options that health care practitioners may consider while caring for people at risk of overdose. As with any other form of care, a practitioner's decision to prescribe certain medications depends on:

• their professional judgement, including whether or not to prescribe a medication outside of its authorized use
• the unique needs of each patient
• the rules and regulations in their province or territory

For more information and to find out what services are available in your area, contact your health care provider, provincial or local health authorities.

Who can access safer supply services

The eligibility criteria for safer supply services depends on those who deliver the services. For some services, participants require a diagnosis of substance use disorder. Others are open to anyone using illegal drugs, because of their high risk of overdose due to the toxic illegal drug supply.

The difference between safer supply and opioid agonist treatment

Opioid agonist treatment (OAT)

Opioid agonist treatment (OAT) is an evidence-based approach for treating opioid use disorder. It involves the use of different medications to prevent withdrawal and lower cravings for opioid drugs. These medications include methadone, buprenorphine, and slow-release oral morphine. Usually, the goal of traditional OAT is for a patient to stop taking drugs.

Safer supply

Safer supply refers to providing prescribed medications as a safer alternative to the toxic illegal drug supply to people who are at high risk of overdose. Safer supply services build on existing approaches that provide medications to treat substance use disorder. However, they are often more flexible and do not necessarily focus on stopping drug use. Instead, they focus on meeting the existing needs of people who use drugs, reducing the risk of overdose by helping people to be less reliant on the toxic illegal drug supply, and providing connections to health and social services where possible and appropriate.

The benefits of safer supply

There is strong national and international evidence supporting OAT with prescribed opioids as an effective treatment for substance use disorder.

While the evidence base for safer supply services is still developing, early research findings are promising and show that these services are associated with:

• lower rates of overdose and individual overdose risk
• reductions in the use of fentanyl and other street-acquired substances
• reduced hospital admissions and emergency room visits
• improved connections to general medical care
• improved connections to housing and social supports
• improved connections to care and treatment for people who have not had support services in the past
• decreased criminal activity
• reduced infections
• overall improvements in health and social wellbeing

Early Findings from Safer Supply Pilot Projects

Health Canada contracted an independent qualitative assessment of ten federally-funded safer supply pilot projects. Information was gathered through surveys and interviews with safer supply program leads, staff and participants between December 2020 and March 2021. This Infographic summarizes early findings, effective implementation strategies, and lessons learned in the establishment of these projects.

To request more information about the independent qualitative assessment findings, please email hc.cdss-scdas.sc@canada.ca.

How we are supporting safer supply

We have taken a number of actions to increase access to safer supply services, including:

• building an evidence base for safer supply by funding pilot projects through the Substance Use and Addictions Program (SUAP), supporting evaluations, and seeking expert advice
• making it easier to access relevant medications, including issuing exemptions from the Controlled Drugs and Substances Act
• sharing resources and guidance on treating substance use disorder for health care practitioners
• hosting a Knowledge Exchange Series to engage a range of safer supply stakeholders in dialogue around current evidence and potential future directions in safer supply

Learn more about our actions to support safer supply and address substance use disorder.

For more information

Learn more about safer supply, problematic substance use during COVID-19, and what we are doing to address Canada's overdose crisis:

• An online toolkit including resources about substance use during COVID-19 and safer supply
  Health Canada toolkit: COVID-19 and substance use
• Highlights of the Government of Canada's actions to address the overdose crisis, such as access to treatment, harm reduction and building evidence
  Federal actions on opioids to date
• Letter sent by the Federal Minister of Health to Provincial and Territorial Ministers of Health and regulatory colleges encouraging better access to safer supply services and action to address the overdose crisis
  Letter from the Minister of Health regarding treatment and safer supply
• Interactive map summarizing actions by the Government of Canada to address the opioid crisis
  Interactive Map: Canada's Response to The Opioid Crisis
• Health Canada actions to support people who use substances and address the overdose crisis during COVID-19
  Helping people who use substances during the COVID-19 pandemic

References

Note: The references below represent both research around medication-assisted treatment, as well as research on safer supply services. While many of these references are not available online, they are listed here for research or reference purposes.

Haasen C, Verthein U, Degkwitz P, Berger J, Krausz M, Naber D. Heroin-assisted treatment for opioid dependence: Randomised controlled trial. British Journal of Psychiatry. 2007;191(1):55-62. https://doi.org/10.1192/bjp.bp.106.026112.

Oviedo-Joekes E, Brissette S, Marsh DC, Lauzon P, Guh D, Anis A, et al. Diacetylmorphine versus methadone for the treatment of opioid addiction. N Engl J Med. 2009;361(8):777-86. https://doi.org/10.1056/NEJMoa0810635.

van den Brink W, Hendriks VM, Blanken P, Koeter MWJ, van Zwieten BJ, van Ree JM. Medical prescription of heroin to treatment resistant heroin addicts: two randomised controlled trials. BMJ. 2003;327(7410):310.

Oviedo-Joekes E, Guh D, Brissette S, Marchand K, MacDonald S, Lock K, et al. Hydromorphone compared with diacetylmorphine for long-term opioid dependence: a randomized clinical trial. JAMA Psychiatry. 2016;73(5):447-55

March J.C., Oviedo-Joekes E., Perea-Milla E., Carrasco F. Controlled trial of prescribed heroin in the treatment of opioid addiction. Journal of Substance Abuse Treatment. 2006;31(2):203-211. doi: 10.1016/j.jsat.2006.04.007

Oviedo-Joekes E., Palis H., Guh D., Marchand K., Brissette S., Harrison S. Treatment with injectable hydromorphone: Comparing retention in double blind and open label treatment periods. Journal of Substance Abuse Treatment. 2019;101:50-54. doi: 10.1016/j.jsat.2019.03.012

Ivsins A, Boyd J, Mayer S, Collins A, Sutherland C, Kerr T, et al. "It's helped me a lot, just like to stay alive": A qualitative analysis of outcomes of a novel hydromorphone tablet distribution program in Vancouver, Canada. J Urban Health. 2020b. https://doi.org/10.1007/s11524-020-00489-9.

Hales J, Kolla G, Man T, O'Reilly E, Rai N, Sereda A. Safer Opioid Supply Programs (SOS): A harm reduction informed guiding document for primary care teams. SOS Guiding Document. 2020. https://bit.ly/3dR3b8m.

BCCSU. What prescribers should know about COVID-19, Substance use, and safe supply - New provincial clinical guidance April 2020. Vancouver, BC: British Columbia Centre on Substance Use, 2020. https://www.bccsu.ca/wp-content/uploads/2020/04/Provincial-Webinars-Prescribers-Final.pdf.

BC Centre for Disease Control. Knowledge Update: Post-mortem detection of hydromorphone among persons identified as having an illicit drug toxicity death since the introduction of Risk Mitigation Guidance prescribing. 2021.

British Columbia Centre on Substance Use, BC Ministry of Health, and Ministry of Mental Health and Addictions. Risk Mitigation in the Context of Dual Health Emergencies—Interim Clinical Guidance: Update. Published January 2022. https://www.bccsu.ca/COVID-19

Ministry of Mental Health and Addictions. (2021). Access to prescribed safer supply in British Columbia: Policy direction. https://www2.gov.bc.ca/assets/gov/overdose-awareness/prescribed_safer_supply_in_bc.pdf

Olding M, Ivsins A, Mayer S, Betsos A, Boyd J, Sutherland C, et al. A low-barrier and comprehensive community-based harm-reduction site in Vancouver, Canada. Am J Public Health. 2020;110(6):833-5. https://doi.org/10.2105/AJPH.2020.305612.

Ivsins A, Boyd J, Mayer S, Collins A, Sutherland C, Kerr T, et al. "It's helped me a lot, just like to stay alive": A qualitative analysis of outcomes of a novel hydromorphone tablet distribution program in Vancouver, Canada. J Urban Health. 2020b. https://doi.org/10.1007/s11524-020-00489-9.

Ivsins A, Boyd J, Beletsky L, McNeil R. Tackling the overdose crisis: the role of safe supply. Int J Drug Policy. 2020;1:102769.

Kolla G, Long C, Perri M, Bowra A and Penn R. Safer Opioid Supply Program: Preliminary Report. London: London Intercommunity Health Centre. 2021. https://www.nss-aps.ca/sites/default/files/resources/2022-LIHC_SOS_Program_Eval_Report.pdf

McNeil R, et al. Implementation of Safe Supply Alternatives During Intersecting COVID-19 and Overdose Health Emergencies in British Columbia, Canada, 2021, American Journal of Public Health, pp. e1-e8. https://ajph.aphapublications.org/doi/10.2105/AJPH.2021.306692

Young S, Kolla G, McCormack D, Campbell T, Leece P, Strike C, Srivastava A, Antoniou T, Bayoumi A, Gomes T. Characterizing safer supply prescribing of immediate release hydromorphone for individuals with opioid use disorder across Ontario, Canada, International Journal of Drug Policy, Volume 102, 2022,103601, ISSN 0955-3959, https://doi.org/10.1016/j.drugpo.2022.103601.

Weng J, et al. Supervised Tablet Injectable Opioid Agonist Therapy (TiOAT), Journal of Addiction Medicine, 2021, doi:10.1097/ADM.0000000000000887

Fischer B, Lee A, Vojtila L. ‘Safer opioid distribution’ as an essential public health intervention for the opioid mortality crisis – Considerations, options and examples towards broad-based implementation. Public Health in Practice, 2020. 1. 100016. 10.1016/j.puhip.2020.100016.