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Prescribed safer supply aims to reduce use and harms associated with the toxic unregulated drug supply, through provision of off-label regulated substances.
In this episode of the Addiction Practice Pod, Dr. Marcus Greatheart and journalist David Ball discuss prescribed safer supply with guests who have on-the-ground experience. First, we hear from harm reduction nurse educator Corey Ranger, on the concept of a “safer supply”, and steps clinicians can take to make prescribed safer supply programs more effective. Corey also shares some lessons learned from participants at the Victoria SAFER Initiative, a prescribed safer supply program in Victoria, BC. From Safer Opioid Supply (SOS) in London, Ontario, Dr. Andrea Sereda discusses the importance of listening to your client’s needs when it comes to their substance use, including what they need to reduce their reliance on the unregulated drug supply, and shares some preliminary data from SOS. We also hear from the co-founder of the Coalition of Substance Users of the North (CSUN), Jenny McDougall, on the importance of providing lower-barrier care options for individuals who are experiencing harms from the unregulated drug supply.
- Describe the potential risks and benefits of utilizing PSS as part of a strategy to reduce harms associated with the unregulated and increasingly toxic drug supply.
- Distinguish between PSS and treatment as an approach for substance use disorders.
- Discuss prescribed safer supply with a patient as a harm reduction option.
In this episode, you’ll hear:
- 5:17 – Corey Ranger – Clinical Nurse Specialist; President, Harm Reduction Nurses Association
- 14:15 – Dr. Andrea Sereda – Family Physician, London InterCommunity Health Centre
- 24:28 – Jenny McDougall – Co-founder, Coalition of Substance Users of the North
Here’s what listeners can take away from this episode:
- Prescribed safer supply is an approach that falls within the continuum of care for substance use disorders. The main goal is to reduce the risk of harms, including drug toxicity death, associated with the unregulated drug supply through provision of regulated substances. This model of care is intended to reach individuals who are at high risk of drug toxicity from unregulated drugs.
- There is an important distinction to be made between prescribed safer supply and substance use treatment. Prescribed safer supply is a novel intervention being trialed for people with a substance use disorder who haven’t benefitted sufficiently from treatment or are not interested in accessing treatment. Prescribed safer supply programs aim to reduce harms by reducing a person’s reliance on the unregulated drug supply. This does not inherently involve reducing or ceasing substance use. In comparison, treatment is focused on using evidence-based interventions to improve quality of life and reduce or stop non-medical substance use. While treatment and harm reduction may have different aims, they are not mutually exclusive; many individuals can and do benefit from both types of care.
- Prescribed safer supply protocols are based on clinical experience. Evaluations are ongoing to assess the safety and effectiveness of prescribed safer supply programs. Unintended consequences, such as diversion, should be taken into account at the individual and community level. As a clinician, this means using prescriber discretion and following the most up-to-date guidance and protocols. Each program should develop its own approach to diversion, prioritizing patient safety, continuity of care, and community safety.
- It is so important to incorporate client-centred care in your practice. Listen to your client and trust them when they tell you what the need, which might be based on what has (or has not) worked for them in the past. Talk with your client about their goals with prescribed safer supply and understand what harm reduction means for them.
- British Columbia Centre on Substance Use (BCCSU). Fentanyl Patch Prescribed Safer Supply Protocols. 2022. Vancouver, B.C.: BCCSU.
- Ministry of Mental Health and Addictions & Ministry of Health. Access to Prescribed Safer Supply in British Columbia: Policy Direction. 2021.
- Gomes T, Kolla G, McCormack D, Sereda A, Kitchen S, Antoniou T. Clinical outcomes and health care costs among people entering a safer opioid supply program in Ontario. CMAJ. 2022;194(36):E1233-E1242.
- Haines M, Tefoglou A, O’Byrne P. Safer Supply Ottawa evaluation: Fall 2022 report. 2022.
- Ivsins A, Boyd J, Mayer S, Collins A, Sutherland C, Kerr T, et al. “It’s helped me a lot, just like to stay alive”: a qualitative analysis of outcomes of a novel hydromorphone tablet distribution program in Vancouver, Canada. J Urban Health. 2021;98:59-69.
- London InterCommunity Health Centre (LIHC). Safer Opioid Supply Program: Preliminary Report. 2021. London, O.N.: LIHC.
- Olding M, Ivsins A, Mayer S, Betsos A, Boyd J, Sutherland C, et al. A low-barrier and comprehensive community-based harm-reduction site in Vancouver, Canada. Am J Public Health. 2021;110:833-5.
- Pauly J, McCall F, Cameron H, et al. A concept mapping study of service user design of safer supply as an alternative to the illicit drug market. Int J Drug Policy. 2022;110.
- Public Health Ontario. Scan of Evidence and Jurisdictional Approaches to Safer Supply. 2022.
- Selfridge M, Card K, Kandler T, et al. Factors associated with 60-day adherence to “safer supply” opioids prescribed under British Columbia’s interim clinical guidance for health care providers to support people who use drugs during COVID-19 and the ongoing overdose emergency. Int J Drug Policy. 2022;105:103709.
- Urbanoski K, Barker B, McGreevy PB, Slaunwhite A, Pauly B. The North American opioid crisis: evidence and nuance on prescribed safer supply. The Lancet (British edition). 2022;400:1402-1403.
- Xavier J, McGreevy PB, McDougall J, et al. Substance Use Patterns and Safer Supply Preferences Among People Who Use Drugs in British Columbia. 2023. Vancouver, B.C.: BC Centre for Disease Control.
- London Intercommunity Health Centre. National Safer Supply Community of Practice. Accessed July 17, 2023. https://www.nss-aps.ca/about-us#what-is-safer-supply.
- Canadian Association of People Who Use Drugs. Safe Supply Concept Document. Zenodo. 2019.
- Nowell M. Safe supply: What is it and what is happening in Canada? CATIE. Februrary 9, 2021. Accessed July 17, 2023. https://www.catie.ca/prevention-in-focus/safe-supply-what-is-it-and-what-is-happening-in-canada.