Stigma, Diversion, and Safer Supply Programs

"Although we only had six women in our study, it is important to highlight the gendered dimensions of medication diversion within SOS [Safer Opioid Supply] programs. Our findings showed a notable example of a woman who transitioned from street sex work to selling prescribed hydromorphone, ultimately ceasing both activities after fully engaging with the SOS program. This experience resonates with reports from other safer supply programs (Sullivan, 2023) and underscores the complex interplay between gender, substance use, and survival strategies. The is a significant finding given the elevated overdose risk among women who use drugs and engage in sex work (Harris et al., 2023). While existing literature on safer supply programs often notes reductions in sex work engagement (Ivsins et al., 2021; McMurchy & Palmer, 2022), there is a lack of gender-specific analyses across SOS programs. Our study thus highlights the need for a more nuanced understanding of how safer supply programs differentially impact individuals based on gender, particularly in relation to diversion practices and associated risk behaviors. Future research should prioritize exploring these gendered experiences to inform more effective and equitable program design and implementation.

"Despite current media attention focused on the potential for substantial diversion of SOS medications (Michaud et al., 2024), empirical evidence remains limited (BC Coroners Service, 2024). However, a growing body of evidence suggests improved clinical outcomes among clients of safer supply programs (Nafeh et al., 2023; Slaunwhite et al., 2024). Qualitative research has found increased stability, autonomy, and reduction of engagement in criminalized activities in the lives of people accessing safer supply programs (Haines & O'Byrne, 2023; Henderson et al., 2024; Nafeh et al., 2023). However, as Nielsen et al. (2024) point out, the evidence base for these novel interventions is still in its early stages, with diverse implementations across varied contexts. As such, a consensus on effective programs and their key features is still evolving, if indeed one will ever fully emerge. Moving forward, it is crucial to conduct high-quality quantitative evaluations with large sample sizes in specific contexts. These studies should incorporate expanded data collection methods to better understand and address potential diversion, rather than dismissing these programs outright based on diversion concerns (Office of the Provincial Health Officer, 2023). Enhancing care for clients who benefit most from SOS programs and implementing robust outcome monitoring allows for refining these interventions, rather than resorting to blanket shutdowns that could have dangerous consequences for their clients. This approach is likely more beneficial than imposing punitive methods to address diversion as seen in OAT treatment where this can be counterproductive (Doernberg et al., 2019; Harris & Rhodes, 2013) and stigmatizing (Markway & Baker, 2011), and could lead to low retention rates in SOS programs (Gomes et al., 2022; Sadek & Saunders, 2022)."