Background:
Prescribed safer supply (PSS) provides people dependent on street-acquired opioids with pharmaceutical opioids - including hydromorphone and fentanyl formulations – to reduce overdose risk. People dependent on unregulated opioids frequently experience significant medical and social complexity, and are disconnected from healthcare services. Our objective was to examine these experiences on client trajectories before and after initiating safer supply.
Methods:
Using comparative case study methods, qualitative interviews and focus groups were conducted with 38 clients and 20 staff members from safer supply programs in two Canadian provinces in 2022. Thematic analysis identified frequent histories of deprescribing among participants prior to initiating PSS, coupled with experiences of rampant stigma/discrimination in healthcare settings.
Results:
Prior to safer supply, many participants experienced medical complexity necessitating high-dose, long-term opioid pain management. Describing stability until abrupt discontinuation of opioid prescriptions, participants were left feeling abandoned by the medical system, with no option but to source opioids from the unregulated drug supply. Participants tried conventional addiction treatment system options that were not helpful, and experienced significant discrimination within the healthcare system. Staff and clients describe successful re-engagement in healthcare through accessing PSS, with clients describing a slow rebuilding of trust in healthcare providers.
Implications:
The role that deprescribing high-dose opioids has played in the overdose crisis is often overlooked, despite previous research documenting how concerns about over-prescribing fueled abrupt discontinuation of prescriptions. Participants experienced deprescribing as medical abandonment, with PSS repairing trust and re-engaging people in healthcare services.