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.
Karen (she/her) is an Associate Professor in Public Health and Social Policy and a Scientist at the Canadian Institute for Substance Use Research at the University of Victoria. She holds the Canada Research Chair in Substance Use, Addictions, and Health Services. Her research focuses on the accessibility and effectiveness of health services for people who use substances and on the social-structural determinants of substance-related harms in the population. She is currently co-leading an evaluation of the implementation and impacts of prescribed safer supply in British Columbia.
Gillian Kolla is an Assistant Professor at Memorial University of Newfoundland, and a Collaborating Scientist at the Canadian Institute for Substance Use Research, University of Victoria. She uses community-based research to explore how to make harm reduction, health and social services more accessible to people who use drugs. She is currently conducting comparative research on the implementation and scale-up of prescribed safer supply programs in two of the Canadian provinces hardest hit by the drug toxicity overdose crisis.
Nancy Henderson is a PhD student at the University of Victoria’s School of Nursing, a research associate at the Canadian Institute for Substance Use Research, and a person with lived experience of drug use and homelessness. Nancy's work focuses on social justice, social and structural determinants of health, people who use drugs, harm reduction, and equitable access to a safer supply.