Background: Illegal opioids are associated with the greatest rates of death and social harm worldwide, and synthetic opioids – notably fentanyl – have contributed to very high overdose death rates in Canada and the United States over the last decade. During the COVID-19 pandemic, the Canadian province of British Columbia, which as long been a world leader in conventional harm reduction approaches, responded to this crisis by starting to provide prescribed safe supply (PSS). PSS provides the same or equivalent opioids via legal and quality-controlled channels as were being purchased illegally. For example, participants may be eligible to receive up to 14 8-mg hydromorphone pills daily, via a low-barrier approach.
Objectives: This paper lays out an economic framework for thinking through the possible intended and unintended consequences of PSS on participants, their associates, potential new initiative, and the broader market, considering potential effects on overdose, addiction, income-generating crime, diversion, and illegal supply, including cross-effects on other substances.
Methods: The unit of analysis is the market, thereby complementing the existing literature which more often takes an individual level frame. The methods are standard market models and methods, informed by review of the literatures on PSS, illegal opioid supply, market prices, and price response. One emphasis is on giving a sense of scale of the various potential effects, favorable and unintended.
Results and Implications: The work is ongoing with an expected completion date of early March 2024, so it is too soon to report results at this time, but they will be available by the time of the conference.