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 and help people live healthier lives. They can also connect people who use drugs to other health and social services.

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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, which is deeply concerning. 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 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. 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:

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 providers, the medications prescribed by safer supply services may include:

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

Where to access safer supply services

There are a number of safer supply service locations in Canada. Some are funded by 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.

Safer supply services may operate out of:

Some health care practitioners are starting to prescribe for safer supply purposes 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:

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 who runs 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.

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 oral medications to prevent withdrawal and lower cravings for opioid drugs. These medications include methadone, buprenorphine/naloxone (Suboxone), 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 their risk of overdose by helping people to be less reliant on 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 the use of prescribed opioids as treatment for substance use disorder, including OAT.

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

How we are supporting safer supply

Health Canada is supporting a number of safer supply projects across Canada funded by the Substance Use and Addictions Program (SUAP).

We have also taken action to increase access to safer supply services by:

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:

References

Note: 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.

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. Barriers and facilitators to a novel low-barrier hydromorphone distribution program in Vancouver, Canada: a qualitative study. Drug Alcohol Depend. 2020a;216:108202.https://doi.org/10.1016/j.drugalcdep.2020.108202.

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.

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