"In British Columbia, a new policy directive—termed “prescribed safer supply”—has recently been announced that will extend prescribing practices outlined in the risk mitigation guidelines beyond the pandemic,29 although the original guidelines remain in effect and have since been revised with a more explicit focus on mitigating COVID-19 risk. However, although the recent policy directive has been broadened to include fentanyl patches and sublingual fentanyl, it does not presently support stimulant prescriptions and thus raises concerns for people who have been accessing stimulants. As the overdose crisis continues, it is imperative that safe supply be extended to all PWUD while being continuously modified to maximize access, efficacy, and equity.

"Finally, our findings draw attention to the tensions surrounding safe supply approaches primarily oriented toward managing withdrawal and drug cravings versus the desire of PWUD to experience enjoyment from drug use.34 There is a need to account for pleasure in the design and implementation of safe supply approaches—something seldom examined in North American research and policy discussions on drug use. Better aligning safe supply approaches with the real-world experiences and desires of PWUD will likely necessitate expanding the options available to include regulated versions of criminalized drugs that they are accustomed to using, such as methamphetamine, cocaine, heroin, and even fentanyl. With growing support for drug decriminalization and strides being made in Oregon and elsewhere,35,36 it is time that these discussions be broadened to also consider what a regulated drug market might look like in North America."


Ryan McNeil, Taylor Fleming, Samara Mayer, Allison Barker, Manal Mansoor, Alex Betsos, Tamar Austin, Sylvia Parusel, Andrew Ivsins, and Jade Boyd. (2022).
Implementation of Safe Supply Alternatives During Intersecting COVID-19 and Overdose Health Emergencies in British Columbia, Canada, 2021. American Journal of Public Health 112, S151_S158, doi.org/10.2105/AJPH.2021.306692