An Overview of the Evaluation of Safer Supply Pilot Programs in Canada
Co-PIs: Mohammad Karamouzian & Dan Werb
Our team has supported data collection through the Centre on Drug Policy Evaluation’s projects and research centers nationwide, evaluating various safer supply service delivery models, including non-witnessed prescribed medications with wraparound care, standalone biometric medication dispensation, and witnessed injectable opioid agonist treatment (iOAT).
Key Findings
1. Barriers to implementing safer supply programs during COVID-19: Analysis of 45 progress reports from 11 pilot programs across three Canadian provinces revealed four main challenge themes: organizational features, outer contexts, intervention characteristics, and implementation process. These included space constraints, staff shortages, limited funds, structural inequities, unmet medication needs, and overly medicalized models.
2. Overdose reduction among a group of Toronto’s safer opioid supply (SOS) program clients: Found ~80% reduction in overdose incidence post-enrollment among a cohort of people who use drugs, improved housing stability, and decreased criminalized activities and law enforcement interactions.
3. SOS medication diversion among a group of SOS clients in Toronto: Identified five themes impacting diversion, including compassionate sharing, unmet medication/survival needs, high demand for safer alternatives in the community, market pricing as a deterrent to diverting SOS medications, and coerced diversion by other community members (Under review).
3. Tablet injectable opioid agonist therapy (TiOAT): A qualitative study of TiOAT programs in rural and smaller urban areas of British Columbia revealed varied access due to geographic challenges, limited transportation, dispensing policies, and access issues in rural hospitals and custodial settings. Despite these barriers, participants reported positive, familial environments at TiOAT clinics, contrasting with stigma experienced elsewhere.
4. Knowledge synthesis of qualitative evidence on patient values and preferences: Clients of programs across the country expressed a need for better and more diverse medication options and flexible dosing and consumption methods. They also preferred programs that value autonomy and shared decision-making. Existing safer supply programs do not fully align with client needs and preferences, and programs should incorporate service user values and preferences to enhance engagement and outcomes. Further research is also needed on non-urban settings and women’s experiences (To be submitted in November 2024).
5. Service providers’ perspectives on barriers and facilitators to safer supply pilot program implementation in Canada: A study of ten safer supply programs across three Canadian provinces identified key implementation facilitators (i.e., ow-barrier, client-centered models, ongoing evaluation, wrap-around care integration, local partnerships, community support, standardized practices, and motivated multidisciplinary teams) and barriers (i.e., toxic unregulated drug supply, complex policies, unsustainable funding, restrictive regulations, limited medication options, space constraints, and staff burnout and shortages) from service providers’ perspectives. Despite internal strengths, programs faced significant external challenges. Findings emphasize the need for stronger policy support and standardized practices to enhance care quality and achieve scale-up (Under review).