Early findings from safer supply pilot projects

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Organization: Health Canada

As the overdose crisis worsened during the COVID-19 pandemic, health care experts and people who use drugs called for greater access to a safer supply of prescription medications as an alternative to the toxic illegal drug supply.

In 2020, the Substance Use and Addictions Program at Health Canada funded ten time-limited safer supply pilot projects in three provinces (British Columbia, Ontario, and New Brunswick). Health Canada then contracted a four-month qualitative assessment, from December 2020 to March 2021, of these projects to capture early learnings, including effective strategies for program delivery.

This is a summary of an independent assessment report prepared by Dale McMurchy Consulting based on information gathered through surveys and interviews with safer supply program leads, staff and participants. While this assessment was funded by Health Canada, the information summarized herein does not necessarily represent the views of Health Canada.

Impact on participants’ lives

Participants said:

Participants and staff say having access to a safer supply of drugs has resulted in improvements to the lives of many participants. They reported that participants:

Medications offered by safer supply programs

In terms of the medications offered by safer supply programs, as an opioid replacement, most participants receive tablet hydromorphone. Fewer receive injectable hydromorphone, fentanyl patches or oxycodone. Many also take a longer-acting opioid (sometimes called a “backbone”), such as methadone or slow-release oral morphine. Some programs also prescribe stimulant replacements (such as methylphenidate and dextroamphetamine).

Participants have effectively developed their own goals and processes for managing their medications. For example, they combine injections and tablets, take their medications as needed throughout the day, and reserve enough to get them through until the next day. Most still struggle to manage withdrawal symptoms, but few have overdosed. While many participants have stopped using street drugs, others still use them, but at a progressively decreasing rate. From the perspective of program staff, it is anticipated that this downward trend will continue with increased participant time in the program and as prescriptions are adjusted to match their needs.

Services offered by safer supply programs

Participants receive a wide range of services in addition to prescription medications through the safer supply programs or referrals to partner organizations. In addition to primary care services (acute, chronic and preventative care), many of the 10 safer supply programs looked at through this evaluation were also offering some combination of the following services:

The safer supply program team

Participants receive support and care from a dedicated and responsive team. The core team often includes a:

According to staff,
“key successes related to staffing have included the benefits of a multidisciplinary team where team members have diverse perspectives and common goals. The team is well-rooted in community harm reduction practice, has a keen social justice analysis, and have established open modes of communication and support.”

Challenges experienced by safer supply programs

The top challenge for programs is the high level of tolerance to fentanyl experienced by participants due to its high potency.

According to program staff,
“for those who have been using fentanyl, their tolerance is such that even maximal doses of Dilaudid [hydromorphone] have little effect except withdrawal management. This leads people to continue to use street fentanyl, as the Dilaudids do not approximate the effect they get from fentanyl.”

Additional challenges met by the programs include:

Demand for a safer supply

Respondents stated that the overdose crisis is not improving and the current safer supply services available across the country are not meeting demand. Many programs have reached capacity or are too busy to take new participants. Broad access to these services, whether through primary care, harm reduction services or other modalities, is needed to meet demand and help address this crisis by providing the necessary services (medications and comprehensive health and social services) to people with substance use disorder.

Programs and staff that continue to innovate based on participants’ experiences, evolving needs and feedback are most effective.

To ensure program success, staff say:

  • "Position people who use drugs as the experts in their own health and wellbeing."
  • "The staff here listen to participants, adapt accordingly, and have seen amazing results."
  • "Participants are the experts in their experience with drug use.  We meet people where they are at and support them with their individual goals."

Key features for effective program design and delivery

The programs reported that the following are important when designing and implementing safer supply services.

Employ a community-centred approach

Take a harm reduction approach

Focus on the participant

Ensure effective management

Understand professional scopes of practice

Develop service processes and procedures

Ensure access and retention

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