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 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 provided herein does not necessarily represent the views of Health Canada.
The assessment found that having access to a safer supply of drugs has had tremendous immeasurable (and measureable) positive impacts on many clients’ lives. Many are more positive and happier, and have better health outcomes, greater stability and improving relationships with family and friends. Some have secured housing and/or employment. They are highly appreciative of having these services available to them. One client shared “It’s surprising; I didn’t think the government would provide this. We are addicts and not really a priority.”
The safer supply programs differ in the range of prescription medication and dosage options offered. 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). Prescribers are working with clients – based on established parameters – to find the approach that works best for them, and clients 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.
It was reported that client needs are evolving and increasingly unsupported by recommended approaches in the existing prescribing guidance and the medications that are currently available. Safer supply programs are finding it difficult to manage client tolerance levels as a result of their fentanyl use. Most clients 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.
Safer supply projects are generally staffed with diverse teams that communicate well and work collaboratively. Staff address many of their clients’ health and social care needs and clients are very appreciative of staff, including the respect and attention they pay. Staff-to-client ratios are high. However, most programs have insufficient funding for the number and type of staff needed to meet overall demand for services and the needs of their current clientele. The safer supply programs benefit from numerous collaborations and partnerships. For example, primary care, pharmacists and supervised consumptions sites are important members of the team. In some instances, they see clients most often. Such reciprocal relationships in support of clients’ health and wellbeing benefit them greatly.
It was reported 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 the demand and help to address the crisis by providing the necessary services (medications and comprehensive health and social services) to people with substance use disorders.
Some of the key lessons learned related to design and implementation are that safer supply programs should:
- be grounded in the community and centred on the input and involvement of people with lived and living experience in program co-design, planning and implementation
- focus on the client and continue to innovate based on clients’ experiences and evolving needs
- have requisite organizational and management structures in place, including processes and protocols outlined
- understand and address federal and provincial legislation and regulations, professional regulations and scopes of practice, and employers’/organizations’ policies and standards
- offer different delivery models to meet client needs and based on the principles of harm reduction
In conclusion, at this early stage of their implementation, the safer supply pilot projects have positively impacted client’s lives. Those working on the ground have seen the results and emphasize the need to expand access to address the overdose crisis and provide medications and comprehensive health and social services to people with opioid use disorder.