What is safe supply?
Safe supply refers to the process of providing controlled drugs such as opioids, stimulants, hallucinogens and marijuana, which are traditionally acquired illegally in the drug market in a regulated and legal manner. Supplying these substances and distributing them in a regulated way acts to reduce the harm posed by these substances.
Key Ideas…
– Safe supply is an element of harm reduction, designed to reduce risks associated with drug use in criminalized contexts and is based on the moral foundation that the individual choosing to participate in drug use has the right to do so.
– Programs look different depending on the community and population it is serving. Programs can provide individuals with prescribed medications to take home where supervision of consumption is not required. Programs can also provide clients with more personalized care from a team including various supports such as doctors, nurses, therapists and outreach works.
– Safe supply programs can be a viable option for eligible participants who are resistant or unsuccessful with other types of treatment, or those who use street drugs in addition to substitution treatments.
– Safe supply provides clients with a reliable and consistent source of their drug, which can help improve their quality of life as it allows more time and energy to be spent on other aspects including (but not limited to) reconnecting with friends and family and securing a job or housing.
– Further research is needed to support evidence informed decision making for these programs. This includes safe supply substances, doses and delivery methods.
“The purpose of safe supply is to provide a safer way for people to access what they are seeking in street drugs.”
– Canadian Association of People who Use Drugs
In order to ensure the success of safe supply strategies, the model must be accessible and provide the intended effect that the client is looking for. The model also must not overburden, invade or punish the client.
The model for different safe supply strategies is dependent upon a number of factors including what kind of drugs it is that are being substituted.
In regard to opioids…
There has been an increase in the prevalence of fentanyl, a highly potent substance, being used as an additive in common opioids sold on the street such as codeine, oxycodone or morphine. Consumers of these street market drugs are often unaware of the presence of fentanyl, fentanyl analogs or other additives in the product. Additionally, the strength of batches and individual doses are quite unpredictable, consequently increasing the risk associated with such street drugs.
“Since 2016, there have been more than 14,700 opioid-related overdose deaths in Canada, with 4614 occurring in 2018 alone. Of those deaths in 2018, seventy six percent of them were related to fentanyl or fentanyl analogs.”
– Ivsins et al., 2020
Due to the significant number of opioid overdoses, it proves extremely important that harm reduction programs be implemented to help protect people in the community.
Safe supply strategies for opioids include prescribing pharmaceutical-grade opioids such as:
- hydromorphone (injectable)
- diacetylmorphine (injectable)
The goal of providing opioid users with these regulated substances is to reduce their need to turn to the illicit drug market, thus reducing the risk of fatal overdose from fentanyl or otherwise adulterated opioids.
In regard to stimulants…
Another trend which has been seen is that the use of stimulants and consequently stimulant related deaths have been on an upward trajectory.
However, previously not much research or effort has been placed on safe supply for stimulants when compared to that of opioids. This may be due to the myth stating that people cannot overdose on stimulants, in addition to the fact that it is not commonly thought that stimulants, such as cocaine or methamphetamines, are being tainted with fentanyl and benzodiazepines. The CDC claims that the occurrence of stimulant related deaths are now comparable to, if not greater than, that of opioids in certain locations proving the above misconceptions wrong. In addition, there has been a significant increase in the amount of cocaine and methamphetamine samples testing positive for fentanyl.
The goal with safe supply of stimulants is the same as for other potentially dangerous drugs, which is to reduce the risk from exposure to these substances by providing a safer alternative to buying them on the street. The alternatives offered must have a similar physiological effect to their illicit counterparts in order to efficiently provide users with the effects they seek from these substances. It has proven difficult to establish an adequate safe supply model for stimulants due to the lack of FDA-approved medications for stimulant use disorders.
Drugs which have been shown to be effective in stimulant use disorders and which may be effective in safe supply programs include:
- High doses of extended-release amphetamines
- Ritalin
- Adderall
- Dexedrine for cocaine use
- Methylphenidate for methamphetamine use
Although safe supply proves beneficial in a lot of substance abuse cases and is a step in the right direction, there are also some limitations to this type of intervention. For some clients that use harder substances or have built up a high tolerance, it can prove extremely difficult for them to find a safe supply option which meets their needs. Thus, they still have to turn to the illicit drug market to get their fix, increasing their risk for overdose.
Canadian Association of People who Use Drugs. (2019). Safe Supply Concept Document. Retrieved from https://vancouver.ca/files/cov/capud-safe-supply-concept-document.pdf
Crighton, K. (2020). Victoria rally calls for decriminalization of drugs after record number of overdose deaths. Sooke News Mirror. Retrieved from https://www.sookenewsmirror.com/news/victoria-rally-calls-for-decriminalization-of-drugs-after-record-number-of-overdose-deaths/
Fleming, T., Barker, A., Ivsins, A., Vakharia, S. and McNeil, R. (2020). Stimulant safe supply: a potential opportunity to respond to the overdose epidemic. Harm Reduct J, 17(6), https://doi.org/10.1186/s12954-019-0351-1
Fleming, T. (2020). Our Need for a Safe Supply of Drugs Includes Stimulants. Filter. Retrieved from https://filtermag.org/safe-supply-stimulants/
Ivsins, A., Boyd, J., Beletsky, L. and McNeil, R.(2020). Tackling the overdose crisis: The role of safe supply. Int J Drug Policy, 80 ,102769. https://doi.org/10.1016/j.drugpo.2020.102769
Selby, P. (2020). How e-prescribing can help address the opioid crisis. The Hamilton Spectator. Retrieved from https://www.thespec.com/opinion/contributors/2020/09/22/how-e-prescribing-can-help-address-the-opioid-crisis.html