"Within Canada, there are various prescribed safer supply models each with the goal of reducing unregulated opioid overdose without requiring cessation of substances. While some programs offer non-opioid safer supply options including stimulants and benzodiazepines, the primary focus remains opioids. These programs range in medications offered, clinical setting, and witnessed or unwitnessed ingestion (Health Canada, 2023b; Ledlie, Garg, et al., 2024).
"Some prescribed safer supply models require patients to consume the medication onsite, under the supervision of staff. Other models provide short-acting opioids as take-home doses (often via daily dispensing) but may require witnessed ingestion for long-acting opioid agonist treatment. Opioid medications offered include oral hydromorphone tablets (the most commonly), injectable hydromorphone, long-acting morphine (M-Eslon ®), oxycodone tablets, fentanyl powder, and fentanyl patches (Klaire et al., 2022; Ledlie, Garg, et al., 2024).
"Program settings are diverse, from dispensing at a pharmacy or biometrically controlled dispensing machine to integration within supervised consumption services, addiction treatment clinics, primary care clinic, or harm reduction housing. Models have also included temporary spaces such as dispensing within COVID-19 isolation spaces (Kolla et al., 2024; Ledlie, Garg, et al., 2024). While the majority of research has focused on dedicated safer supply clinics or those receiving federal funding, a notable proportion of safer supply prescribing has occurred in existing primary care clinics, although in British Columbia (BC) much of the scale-up was driven by specialized addiction medicine providers (Glegg et al., 2022).
"Policies that necessitate witnessed ingestion multiple times a day pose a substantial barrier for many patients, and can lead to return to use of toxic drugs (Bardwell et al., 2023). However, witnessed dosing remains a common practice due to concerns of diversion, which is the selling or sharing of safer supply medication to/with others."
Patty Wilson, Kate Colizza, Elaine Hyshka, Safer supply and political interference in medical practice: Alberta's Narcotics Transition Services, International Journal of Drug Policy, Volume 133, 2024, 104600, ISSN 0955-3959, doi.org/10.1016/j.drugpo.2024.104600.
