Gillian Kolla is a Banting Postdoctoral Researcher at the Canadian Institute for Substance Use Research, University of Victoria, Canada. She uses primarily community-based qualitative and ethnographic research to explore how to make health and social services more accessible to people who use drugs.

Background: In response to the devastating overdose/drug policy crisis in Canada driven by an unregulated opioid supply predominantly composed of fentanyl/analogues, safer opioid supply programs have been introduced. Safer supply programs provide people dependent on street-acquired opioids with prescribed, pharmaceutical opioids - including hydromorphone and fentanyl formulations - in a variety of program models to reduce overdose risk.

Methodology: Using comparative case study methods, qualitative interviews and focus groups were conducted with 38 safer supply clients drawn from safer supply programs in two Canadian provinces (BC and Ontario) where safer supply scale-up is occurring, but using different program models. Thematic analysis was used to identify impacts of safer supply prescribing and program model characteristics that may impact client outcomes.

Results: Participants detailed how their health and social functioning improved after initiating safer supply, and that their overdose risk dropped. Additional benefits included less involvement in street hustles, leading to stability and improvements in quality of life. Participants in BC receiving observed doses of fentanyl formulations appreciated receiving pharmaceutical sources of fentanyl, but desired access to take-home doses and less frequent clinic visits. Ontario participants – with access only to take-homes doses of hydromorphone - highlighted a need for access to more potent opioid formulations. Accustomed to take-home doses, Ontario participants voiced opposition to the idea that other opioids might necessitate observed dosing as they did not wish to be ‘chained’ to a clinic several times a day. All participants desired more medication options, particularly heroin.

Conclusion: Safer supply clients overwhelmingly appreciated the programs and felt they were lifesaving. Service models attempted to prioritize a harm reduction approach and provide medications that would best meet participants’ needs; however, this was in tension with the constraints of medicalized safer supply that required observed dosing, frequent clinic visits and limited medication options.