Barriers to Implementation of Safer Supply Programs

"Several client- and provider-reported barriers to safer opioid supply program engagement were also identified. Provider identified barriers to prescribing opioids for the purposes of safer supply primarily reflected a perceived lack of guidance and training with the introduction of the Risk Mitigation Guidance in British Columbia (Giang et al., 2023; Kalicum, 2023; Mansoor et al., 2023), and the limited evidence base regarding the effectiveness and safety of safer opioid supply. For providers, some facilitators to safer opioid supply programs were also identified and included belonging to a team (Foreman-Mackey et al., 2022), as well as strong communication between providers (Mansoor et al., 2023). Barriers reported by clients included challenges accessing safer opioid supply prescribed drugs when program policies mandated multiple visits throughout the day to obtain the complete daily dose (Atkinson, 2023; Haines & O'Byrne, 2023a; Ivsins et al., 2020), and lack of familiarity with the program by non-safer opioid supply providers (Haines et al., 2022; Kolla et al., 2021). The mismatch between the potency of the unregulated drug supply and what was prescribed to safer opioid supply clients was also identified as a limitation of safer opioid supply programs (Atkinson, 2023; Bardwell et al., 2023; Giang et al., 2023; Haines & O'Byrne, 2023a; Haines et al., 2022; Ivsins et al., 2020; Karamouzian et al., 2023; Kolla et al., 2021; McNeil et al., 2022). In particular, the lack of availability of higher potency opioids and multiple formulations that allow for consumption by either injection or inhalation was described in some studies as leading to continued use of unregulated drugs, which may undermine the effectiveness of safer opioid supply programs for prevention of toxicity events. This aligns with a recent study conducted in Ontario, which found a shift in the mode of drug use toward inhalation, contributing significantly to opioid toxicity deaths (MacDonald et al., 2023). A survey conducted among people who use drugs in British Columbia also found that half of respondents would prefer smokeable options if they were provided by safer opioid supply program. Kamal et al., 2023). Furthermore, as the opioid toxicity crisis continues to evolve across North America, polysubstance use is increasingly associated with substance-related deaths (Konefal et al., 2022; Park et al., 2022). In addition to the availability of higher potency opioids, provision of non-opioid prescription medication should continue to be implemented. This is supported by findings generated from interviews conducted with people who use drugs highlighting the need for access to a regulated supply of stimulants and benzodiazepines for people currently accessing these substances from the unregulated supply and to help prevent non-opioid related withdrawal symptoms when transitioning to safer supply programs (Canadian Community Epidemiology Network on Drug Use., 2021; Xavier et al., 2023). Together, identified barriers, facilitators, and suggestions for the improvement of safer supply programs may help to inform the implementation, scale-up and operation of current and future safer supply programs."