Mohammad Karamouzian is an infectious disease epidemiologist with the Centre on Drug Policy Evaluation. Dr. Karamouzian’s research focuses on addressing health inequities faced by marginalized populations, such as female sex workers, people who inject drugs, and incarcerated people.

BACKGROUND: Canada is experiencing an unprecedented drug overdose epidemic related to a highly toxic unregulated drug supply. In 2019, safer supply pilot programs (SSPPs), a low-threshold and patient-oriented model of medication-assisted treatment that includes non-witnessed ingestion of prescribed opioids and other substances, were introduced primarily to prevent overdose mortality. Given the recent emergence of SSPPs and a lack of data on challenges to sustainability, we sought to document SSPPs’ organizational experiences in the first two years of their implementation using progress reports submitted by SSPPs to their federal funder, Health Canada.
METHODS: Organizational progress reports (2019-2022) were obtained from 11 harm reduction centres implementing SSPPs in three provinces. Data were analyzed using deductive and inductive approaches via qualitative content analysis, and informed by the consolidated framework for implementation research.
RESULTS: In all, we obtained 45 progress reports from 11 SSPPs. Six centres were based in British Columbia, four in Ontario, and one in New Brunswick. Three overarching themes were identified to describe the challenges faced during establishing and implementing SSPPs: i) Organizational-level influences (e.g., physical space constraints, staff shortages); ii) local socio-economic and policy contexts (e.g., limited operational funds, clients’ structural vulnerabilities) and iii) Implementation barriers (e.g., pandemic-related challenges, medication-related challenges, overly medicalized safer supply models, public concerns).
CONCLUSIONS: SSPPs in Canada face multiple internal and external implementation barriers. Given the important role of safer supply initiatives in addressing the drug overdose epidemic in Canada and their potential scale-up in the future, services should be well-supported during their implementation phases. Revising and revisiting service provision within safer supply programs based on the feedback and experience of clients and program administrators is warranted, along with efforts to ensure that appropriate medications are available to meet the needs of clients.