Dr. Katherine Rudzinski is an adjunct assistant professor and a SSHRC-funded postdoctoral research fellow and in the School of Social Work, University of Windsor. Katherine is dedicated to working with and for people who use drugs on community-based research projects which examine issues of harm reduction, substance use and well-being.

Background: In response to the devastating opioid overdose crisis, Canada is piloting safer opioid supply programs (SSPs) which provide individuals who use illicit opioids with an 'off label' prescription for pharmaceutical-grade alternatives. Although the primary purpose of SSPs was to reduce overdose deaths and health-related harms stemming from exposure to toxic street drugs, these programs are having a broader impact.

Methods: Between February and October 2021, we conducted semi-structured qualitative interviews with n=27 service providers and n=52 clients at four SSPs in Ontario, Canada to examine perceived impacts of SSP engagement on criminalized income-generating activities. Thematic analysis was conducted in MAXQDA and descriptive statistics in SPSSv28.

Results: Prior to starting SSPs, most clients had long histories of criminal justice system involvement. Both clients and providers discussed how SSP participation reduced clients’ need to engage in criminalized income-generating activities (e.g., theft, sex work) and decreased their interactions with police and the criminal justice system (e.g., reducing the risk of arrest and incarceration). Some clients spoke about how having access to a reliable safer supply changed their lives by reducing their risk of interpersonal violence, which occurred when obtaining drugs and/or having to victimize other people to afford drugs. This allowed some clients to break the cycle of incarceration and release thereby increasing their overall stability and safety. Some clients spoke about changes to their self-identity stemming from no longer having to victimize others to obtain drugs. However, clients who were incarcerated while on SSPs faced treatment interruptions.

Conclusions: By eliminating the need for many of the income-generating activities associated with illicit drug use that lead to negative outcomes (e.g., violence, incarceration), SSPs have the potential to increase safety and stability for people who use drugs, including improving their social and structural determinants of health (income, food, housing security) and their self-identity.