Since the Early 2000s, Canada and the United States have been experiencing an unprecedented public health crisis from acute drug toxicity fatalities (“drug death crisis”) that is estimated to have claimed well beyond 1 million lives. Although initially driven mostly by fatalities from potent prescription opioids, over the past decade this crisis has changed to being propelled mostly by highly potent and toxic illicit/synthetic opioids (ISOs; e.g., fentanyl and analogues) (Ciccarone, 2021; Fischer, 2023). In 2021, Canada recorded 8,006 opioid-toxicity deaths, for an age-adjusted rate of 21.2/100,000 population (Federal, Provincial, and Territorial Special Advisory Committee on the Epidemic of Opioid Overdoses, 2023). During the same year, there were 106,699 drug overdose deaths (32.4/100,000) in the United States (Spencer et al., 2022). Although this death toll in absolute numbers and rates is even graver in the United States than in Canada, it has been shown to adversely affect life expectancy in both countries.

In Canada, comprehensive intervention efforts have been implemented and expanded over time to address this drug death crisis. These have included, for example, extensive scale-up of supervised consumption (or “overdose prevention”) services, naloxone distribution (for opioid overdose reversal), and treatment availability (including different opioid agonist therapy [OAT] formulations/modalities) for opioid use disorder (OUD) (Antoniou et al., 2020; Kennedy et al., 2022; Papamihali et al., 2020; Piske et al., 2020). These measures, however, have not been able to stem the rising tide of drug deaths. The levels of drug toxicity deaths in Canada have continuously increased (up to and including 2021), and more recent indicators suggest no significant changes moving forward (Federal, Provincial, and Territorial Special Advisory Committee on the Epidemic of Opioid Overdoses, 2023).

Safer drug supply rationale and concept

The extremely potent and toxic nature of ISOs has rendered them the primary cause of overdose fatalities while consequently presenting major challenges for the menu of available interventions. Many existing interventions have mostly aimed at either manipulating the drug use environment to be safer (e.g., supervised consumption) or reactively treating underlying drug use disorders (OAT) or overdoses (naloxone). These approaches, however, have limited direct impact on the primary vector of highly potent and toxic ISO drugs causing overdose deaths (Fischer et al., 2019, 2020b). For illustration: More than half of recent overdose fatalities in British Columbia have occurred from inhalation rather than injection drug use—a mode of use traditionally viewed as substantially safer and protective against overdose-related death (BC Coroners, 2023; Fischer, 2023;Thiblin et al., 2004).

The search for more effective interventions has thus increasingly focused on the need for safer drug supply provision as an emergency measure to address and reduce the risk of deaths caused by ISO exposure (Ivsins et al., 2020; Tyndall, 2020). Conceptually and practically, safer supply measures provide a form of vector intervention toward reducing the drug consumer's exposure to highly potent/toxic ISO drugs and therefore the consequential risk of overdose death (Fischer et al., 2020b). Based on this premise, the first Canadian small-scale safer supply programs began operating in Ontario from 2017 onward, initially providing prescribed pharmaceutical-grade hydromorphone to small numbers of at-risk drug consumers. Similar programs were subsequently implemented in other locations, with some offering alternative opioid formulations and/or dispensing modes. Safer supply programs became officially supported by the federal government of Canada as of 2020 (Government of Canada, 2023; Harris et al., 2021; Tyndall, 2020; Young et al., 2022). In 2021, the province of British Columbia phased in its formal prescribed safer supply policy for regulatory guidance (Ministry of Mental Health and Addictions, 2021).

Criticism and opposition

Safer supply initiatives have received critical examinations and opposition, from voices both within and outside of Canada, including the United States, where the drug-related death toll is extreme, yet safer supply programming is generally absent (Willow et al. 2020; Zivo, 2023). For example, Roberts and Humphreys (2023) suggested that safer supply measures involve “reduced … healthcare professional consultation, supervision and/or the need for a formal prescription to directly provide [PWUD] with pharmaceutical grade medications”; they may represent a possible “recipe for harm through […] supply induced toxicity and overdose” … extending “both to the individual provided with the medication [… and to …] others to whom the ‘safe supply’ medication becomes diverted”; inadequate “professional oversight” may provide “a stigmatized population a lower quality of care than would be considered ethical for other patients” (Roberts & Humphreys, 2023). Elsewhere, Kilmer and Pardo (2022) express concern about the “ambiguity surrounding safer supply” practices (including their substance, supervision, and dispensing), which could lead to barriers for implementing “new medication treatments,” specifically for OUD (Kilmer & Pardo, 2023). The implied criticisms are, in part, substantive and grave. They are used in this paper as a starting point for offering some elementary clarifications and perspectives with regard to the rationale, concept, and practical elements of safer supply measures.

Clarifications and comparisons

First, safer supply initiatives are neither designed nor practiced as an addiction treatment type of intervention. Sociomedical discourses of addiction have gradually shifted from a crime or moral defect of the host individual to that of a disease framing in recent decades. Yet, the view that the addictive state presents a behavioral deficiency for which treatment is necessary toward the patient's recovery (typically involving abstinence from substance use) remains, especially in the distinct socio-ideological contexts of the United States (Bart, 2012; Bourgois, 2000; Clark, 2017). Although both intervention types can include an element of pharmaceutical medication (e.g., methadone or buprenorphine as blockers for conventional OAT) provision, they do so with largely different objectives. Overall, safer supply measures do not principally operate toward goals of treatment or recovery. In these contexts, safer supply programs are often contrasted with traditional treatment approaches for OUD, for which expansions are advocated in a commonly dichotomized, and thereby misleading, perspective as the superior alternative. However, the reality-based need for safer supply programming needs to be viewed within the profound limitations of available treatment options, such as their limited uptake, prohibitive requirements for entry, and low retention rates. For example, only about half (or substantially less) of individuals with OUD are reached by and effectively retained in OAT programming, leaving extensive subgroups without related overdose and mortality protection effects (O’Connor et al., 2020; Piske et al., 2020; Shulman et al., 2021). On this basis, safer supply measures in reality aim to complement rather than compete with available treatment options. They, instead, seek to function as but one part of the interventions and care continuum for high-risk substance use, addressing some of the extensive shortcomings in acute mortality risk protection in current drug death crisis conditions.

Safer supply programming is thus primarily conceived and implemented as an emergency health or survival intervention that aims to protectively replace the potent/toxic ISO supply, thereby decreasing the risk of acute overdose and death (Ivsins et al., 2020; Tyndall, 2020). Conceptually, it may viewed similarly to efforts providing “safer” (e.g., smokeless) tobacco products to abstinence-resistant smokers to reduce related acute risk for chronic morbidity and/or mortality (Hatsukami et al., 2007; Kozlowski, 2007). On this basis, safer supply measures may be perceived as being more akin to forms of emergency or survival care interventions performed in nonclinical settings, such as CPR provided by civilians in cases of cardiac arrest, roadside injury/first aid care at an accident scene, or improvised emergency health care in remote settings (Abella et al., 2008; Fischer et al., 2020b; Mock et al., 2004). These examples of emergency/ survival-oriented interventions typically occur with only limited medical consultation or supervision and may even fail, or produce harm to their targets. Their principal aim is the protection of human life in contexts of an emergency crisis, and the appropriateness or ethicality of these interventions as potentially lifesaving measures is not fundamentally questioned. As such, it is plausible to argue that safer supply initiatives do not violate standards of good or ethical medical practice, but rather represent an imperative form of emergency health and survival care for many individuals in circumstances of unprecedented, acute risk for overdose death (Csete & Elliott, 2021; Tyndall, 2020).

Above-cited criticisms implied that safer supply occurs without adequate health-professional consultation, prescription, and supervision. More than 75% of acute drug deaths in British Columbia occur in private or other residence settings—scenarios in which the presence or consultation by health care professionals to provide acute overdose care is absent, similar to bystander-provided CPR or other first aid/emergency measures. In addition, current programming standards in Canada stipulate that safer supply medications are provided to participants based on a healthcare provider's prescription (Duthie et al., 2023; Ministry of Mental Health and Addictions, 2021;Young et al., 2022). This practice is not generally different from medical provision practices for other chronic disease medications (e.g., psychotropics) that are commonly prescribed to large patient populations and carry risk for harm and/or death (Jain et al., 2012). The approach also needs to be compared with the medical prescribing practices through the early 2000s, when large segments of the general population (20% or more in Canada) received prescription opioids for mostly morbidity/pain indications, despite limited evidence for their efficacy and safety, in high doses and/or long-term duration (Busse et al., 2018; Fischer et al., 2020; Gomes et al., 2014; Schieber et al., 2019). In comparison, safer opioid supply prescribing occurs as a relatively targeted and limited measure, centrally aiming for at-risk populations for acute death as opposed to the population at large.

Evidence

Although safer supply programming is still in its infancy, evidence on health outcomes associated with it is emerging and accumulating. For example, in a shelter-based safer supply program in Hamilton, Ontario (2021), the rate of nonfatal overdoses fell from 0.93/100 to 0.17/100 nights of shelter-bed occupancy in the initial month of programming (odds ratio = 5.5, 95% CI [1.63, 18.55]) (Lew et al., 2022). In the initial client cohort (n = 26) of Ottawa's Managed Opioid Program (2017–2018), more than half of participants experienced no overdoses and no deaths occurred. In addition, 45% of study participants stopped nonprescribed opioid use and 96% connected to health services after 1 year (Harris et al., 2021). Among safer opioid supply program participants (n = 82) in London, Ontario (2016–2019) and a matched control group of unexposed individuals (n = 303), time-series analyses found that rates of emergency department visits (-14 visits/100, 95% CI [-26, -2]), hospital admissions (-5 admissions/100, 95% CI [-9, -2]), and (nonprimary care or medications) health care costs (-$922/ person, 95% CI [-$1577, -$268]) declined significantly after program entry. In the year after cohort entry, the rate of emergency department visits (relative risk [RR] = 0.69, 95% CI [0.53, 0.90]), hospital admissions (RR = 0.46, 95% CI [0.29, 0.74]), and admissions for incident infections (RR = 0.51, 95% CI [0.27, 0.96]) declined significantly, and health care costs were halved among participants, with no signifi-cant changes among controls (Gomes et al., 2022).

In qualitative evaluations of different safer supply modalities providing pharmaceutical-grade hydromorphone in Vancouver, participants reported reductions of illicit drug use and overdose risk and improvements in health and well-being (Bardwell et al., 2023; Ivsins et al., 2021; McNeil et al., 2022). Other evaluations have reported similar reductions and additional—including personal/social—benefits from safer supply provision (Gagnon et al., 2023; Haines & O’Byrne, 2023). The accumulating evidence on safer supply–associated benefits for participants’health outcomes may gradually solidify its status as an evidence-based intervention similar to that of other interventions (e.g., OAT) in which specific subgroups of individuals who use drugs show significantly improved health risk outcomes (Bell & Strang, 2020).

Diversion

Although there is limited but plausible evidence to date that safer supply provision produces acute health protection effects concerning fatal overdose risk for participants, risk remains for one significant adverse outcome for public health: diversion. Diversion is recognized as a main challenge for addictive substance sourcing and control, whether in general or in medical—including addiction treatment—settings (Babor et al., 2018; Bell & Strang, 2020; Fischer et al., 2010). Although the extent of safer supply–related diversion currently remains unclear, this phenomenon has recently been purported, mostly by concept opponents, as a primary collateral harm of safer supply programming (Willows et al., 2020; Zivo, 2023). Select local safer supply programs have found diversion rates to be low, although more comprehensive and better data are required to fully assess this (Brothers et al., 2022). Overall, the dynamics of safer supply–related diversion within the distinct real-life world of addictive substance use are complex and challenging. Recent investigations have insightfully characterized the phenomenon of safer supply–related diversion within contexts of prohibition, poverty, and marginalization, where the selling or trading of (including safer supply–provided) substances may occur for existential purposes and needs yet where diversion may produce “positive effects in providing a safer drug supply to others” amidst an acute drug death crisis (Bardwell et al., 2021).

Such benefits may indeed materialize when diverted safer supply drugs replace otherwise riskier drug use among other users. This, however, may be less likely when the effects of diversion in themselves cause or add to substance use–related risks or harms (e.g., overdose) among others. This should be acknowledged by safer supply proponents as much as it is emphasized by its opponents, as the putative public health benefits of safer supply provision may risk being offset by unintended adverse consequences. Some degree of diversion occurs and is tolerated for most psychotropic medications, as well as for other restricted products that include substantive harm potential (e.g., alcohol, tobacco, firearms) (Berge et al., 2012; Braga et al., 2012; Crifasi et al., 2019; Hulme et al., 2018). The possibility of diversion therefore ought not be framed as a categorical issue against the legitimacy of safer supply programming. Rather it should be viewed and assessed in terms of proportional benefits versus collateral harms. That is, safer supply provisions should be considered as a legitimate intervention amidst current drug death crisis conditions realities as long as possible collateral harm effects (e.g., diversion with harmful effects among others) do not outweigh protective health effects (Duthie et al., 2023). To date, there is no population-level evidence that the drug types involved in safer supply (e.g., hydromorphone) measures have causally contributed to marked increases in collateral harm (e.g., toxicity deaths) (BC Coroners, 2023). However, additional and more comprehensive monitoring data are needed (e.g., including on the extent of diversion and overdose/fatality incidents involving diverted safer supply substances among recipients or others) to adequately assess this aspect of safer supply.

Furthermore, given the potential of diversion to undermine the public health benefits of safer supply programming, regulation and design schemes should be advanced that reduce its likelihood while protecting easy access and utilization goals. This is much easier preached than practiced and may involve possible delicate trade-offs toward threshold-elevating. One element toward reducing diversion risk from safer supply—recognizing drug users’ natural desires to obtain better drugs—rests in offering preferred substance types and formulations to participants. Empirical data to guide related programming design exist (Bardwell, 2022; Ferguson et al., 2022; Kamal et al., 2023). Even with addictive drug use set largely within the dire circumstances of users’ common poverty, marginalization, and extensive (e.g., mental) health problems, elements of practical awareness by participants as to the importance of limiting the potential adverse effects of diversion are needed to protect the fundamental viability of safer supply programming. One path to limiting diversion opportunities may be through low-barrier, but reasonable amount-/frequency-limited dispensing of safer supply drugs in community-based settings.

Nomenclature

For an additional symbolic but nontrivial point, there should be general and practices agreement among professionals, proponents, and service users alike on the fact that safer supply activities ought not to be named or labeled safe supply (i.e., an absolute term). The provision and use of psychoactive (opioid) substances through safer supply programming, even prescription-based and in pharmaceutical-grade form, is not a categorically safe event. The substances involved can still produce severe harm, including overdose and death. Here, language matters too (Barry et al., 2018), and belief-driven practices of mislabeling safer supply in undue promotional ways are similar to misrepresenting them as categorically unsafe or harmful and invites undue polarization and/or reactance (Kilmer & Pardo, 2022; Willows et al. 2020). Safer supply initiatives are public health–guided measures to reduce excessive, vector-based risks of acute overdose death in contexts of a potent/toxic drug supply–fueled public health crisis. They, however, can offer these effects only to limited, and nowhere near absolute, extents; related nomenclature should honestly reflect these realities.

Conclusions

A decade into the unprecedented drug death crisis from toxic ISO supply, the measures required to effectively solve this crisis have yet to be identified and implemented. Some 15 years ago, observers contemplated the “unthinkable” question whether the—even predominatly diverted—use of prescription opioids brought protective health effects over the use of illicit opioids for users. Today, this perspective has new and current relevance (Fischer et al., 2009). In present-day Canada, safer supply initiatives as an emergency public health measure to reduce risk for overdose death from toxic ISOs are being gradually ramped up in local settings. Initial evidence suggests that they can produce substantive health and other benefits for participants, although more comprehensive monitoring data are needed to better assess their desired and/or unintended population-level impacts. Safer supply measures, however, should not be held to standards different than those used for other emergency-based interventions, nor to the idealized (and commonly unachieved) goals of recovery-oriented addiction treatment. Possible diversion of safer supply medications and related adverse outcomes is a valid concern for public health, which is not unlike experiences in other domains. Acutely facing the horrific drug death crisis, safer supply initiatives ought to be considered an ethically imperative, setting-specific intervention, unless other interventions can be used that effectively protect opioid users from extreme risk of acute death and/or empirical data robustly demonstrate that they produce more collateral harm than benefits on population levels (Duthie et al., 2023; Fischer, 2023; Ivsins et al., 2020; Tyndall, 2020).

It is worth noting here also that intervention approaches and standards for most diseases are socioculturally and value contingent. Canada's current public health approach to the drug death crisis imperatively requires the provision of safer supply programming to address essential intervention gaps. These measures remain sociopolitically controversial but are supported by population majorities in several (even conservative-leaning) provinces (Fischer, 2023; Morris et al., 2023). Of course, if—within contexts of an even more severe crisis—treatment intervention options (e.g., involving novel medications and/or intensive supervision-based programming) are documented (e.g., in the United States) that decisively reduce the record levels of overdose deaths, related facts ought to be promptly considered for implementation. Until then, Canadian policy and intervention systems are urged to mobilize all currently promising and demonstrably effective available measures. This includes the broad-based implementation of safer supply programming to better protect drug users’ and the public's health as related to the continuous drug death crisis, which has unnecessarily claimed far too many lives already.

This work has been supported in part by Canadian Institutes of Health Research Grant FRN-94814. Benedikt Fischer has held research grants and contracts in the areas of substance use, health, and policy from public funding and government organizations (i.e., public-only sources).Tessa Robinson has no competing interests to declare.

The Unprecedented Drug Death Crisis in North America

A significant public health crisis stemming from acute drug toxicity fatalities has affected Canada and the United States since the early 2000s. This crisis, initially characterized by prescription opioid fatalities, has evolved, with highly potent illicit and synthetic opioids (ISOs) such as fentanyl now being the primary driver. The resulting mortality rates present a substantial challenge to public health systems in both nations.

Intervention Efforts and Their Limitations

Canada has implemented various interventions to address this crisis, including supervised consumption services, naloxone distribution, and expanded access to opioid agonist therapy (OAT) for opioid use disorder (OUD). Despite these efforts, drug-related deaths have continued to rise, highlighting the limitations of current approaches in mitigating the impact of highly toxic ISOs.

Safer Drug Supply: Rationale and Concept

The highly potent nature of ISOs presents significant challenges for existing interventions. Strategies focused on environmental manipulation (supervised consumption) or reactive treatment (OAT, naloxone) have limited impact on the primary issue of exposure to potent ISOs. Safer supply initiatives aim to directly address this by providing a regulated alternative to the highly toxic illicit drug supply, thereby reducing the risk of overdose. The implementation of these programs has grown since their initial introduction, with government support now established.

Criticism and Opposition to Safer Supply

Safer supply initiatives have faced criticism, primarily concerning potential risks of diversion, inadequate professional oversight, and concerns about supply-induced toxicity. Critics argue that these programs may inadvertently exacerbate the problem, leading to increased harm among both participants and those to whom the medications are diverted. These concerns warrant careful consideration and a thorough evaluation of the program's design and implementation.

Clarifications and Comparisons to Other Interventions

Safer supply programs are not intended as addiction treatment but rather as an emergency public health measure to reduce acute mortality risk. They are designed to complement existing treatment options, addressing gaps in current interventions. This approach is comparable to other emergency interventions, such as CPR or roadside first aid, where the primary goal is life preservation.

Evidence Supporting Safer Supply

Emerging evidence suggests that safer supply programs are associated with reduced nonfatal overdoses, emergency department visits, hospital admissions, and healthcare costs. Qualitative evaluations have also shown improvements in participants' health and well-being, reducing illicit drug use and associated harms. However, further research is needed to fully assess the long-term impacts and population-level effectiveness of these initiatives.

Diversion: A Key Concern

Diversion of safer supply medications is a legitimate concern. While the extent of this issue remains uncertain, research is needed to quantify the effects of diversion. The potential for both positive and negative outcomes associated with diversion is significant and needs careful consideration. This necessitates a balanced perspective accounting for potential benefits versus collateral harms. Current evidence does not show a causal link between safer supply programs and increased mortality from drugs commonly used in these programs.

Nomenclature and Honest Communication

The terminology used to describe safer supply initiatives is critical. The term "safe supply" is misleading, as the provided substances still carry risks. Accurate and transparent language is essential to foster informed discussion and avoid misinterpretations.

Conclusions and Future Directions

Safer supply programs represent a potentially crucial emergency intervention in the context of the ongoing drug death crisis. While challenges remain, particularly regarding diversion, initial evidence suggests that these programs offer potential health benefits. Continued monitoring and research are crucial for optimizing their design and implementation to ensure they effectively address the urgent public health crisis. Additional innovative treatment options remain critically needed.

Summary

Since the early 2000s, Canada and the United States have faced a significant public health crisis due to drug toxicity fatalities. Initially driven by prescription opioids, the crisis is now largely fueled by highly potent illicit synthetic opioids (ISOs), such as fentanyl. In 2021, Canada reported 8,006 opioid-toxicity deaths, while the United States recorded 106,699 drug overdose deaths. This crisis negatively impacts life expectancy in both nations.

Safer Drug Supply Rationale and Concept

Despite interventions like supervised consumption services and opioid agonist therapy (OAT), drug deaths continue to rise. The high potency and toxicity of ISOs present challenges for existing interventions. Many focus on safer drug use environments or treating existing disorders, but these have limited impact on the primary cause: highly potent ISOs. The rising death toll, even in cases of inhalation, highlights the need for more effective strategies. Safer supply programs aim to reduce overdose risk by providing less toxic substances. These programs began in Canada in 2017 and gained federal support in 2020. British Columbia implemented a formal safer supply policy in 2021.

Criticism and Opposition

Safer supply initiatives face criticism, both domestically and internationally. Concerns exist about reduced healthcare professional involvement, the potential for supply-induced toxicity and overdose, and inadequate oversight. The ambiguity surrounding implementation practices, including substance, supervision, and dispensing, also raises concerns regarding integration with other medication treatments for opioid use disorder (OUD).

Clarifications and Comparisons

Safer supply is not primarily an addiction treatment; its goal is harm reduction. While both safer supply and OAT utilize pharmaceutical medications, their objectives differ significantly. Safer supply aims to complement, not compete with, existing treatment options due to limitations in treatment access and retention rates. The approach is compared to emergency interventions like CPR—high-risk, time-sensitive interventions with the primary aim of saving lives, even if imperfect.

Evidence

Emerging evidence suggests positive health outcomes from safer supply programs. Studies report reduced nonfatal overdoses, decreased emergency department visits and hospital admissions, reduced healthcare costs, and improvements in health and well-being among participants. These results suggest that safer supply may become an evidence-based intervention alongside OAT.

Diversion

A major concern is diversion of safer supply drugs. Although the extent is unclear, it's a significant risk to public health. Some programs have shown low diversion rates, but more data are needed. Diversion needs to be considered in relation to the overall benefits of safer supply; the potential for harm must be weighed against the lives saved. Current data do not show a causal link between safer supply drugs and increased overdose deaths. However, continued monitoring is crucial.

Nomenclature

The term "safe supply" is inaccurate because the provided substances, even pharmaceutical-grade, can still cause harm. More accurate and less polarizing terminology is needed.

Conclusions

The drug death crisis demands effective solutions. Safer supply initiatives show promise in reducing overdose deaths, but more data are necessary. These programs shouldn't be held to different standards than other emergency interventions. Diversion is a concern but shouldn’t negate the potential benefits, particularly given the severe crisis. Until more effective interventions are available, safer supply initiatives remain a crucial part of a comprehensive strategy.

Summary

Since the early 2000s, Canada and the United States have faced a severe public health crisis due to drug overdose deaths. Initially caused by prescription opioids, the crisis is now largely driven by potent illicit synthetic opioids (ISOs) like fentanyl. In 2021, Canada saw 8,006 opioid-related deaths, while the United States recorded 106,699. This has negatively impacted life expectancy in both nations.

Safer Drug Supply Rationale and Concept

The high toxicity of ISOs makes existing interventions, such as supervised consumption services and opioid agonist therapy (OAT), less effective. Many overdoses now occur through inhalation, previously considered a safer method. Safer supply programs aim to reduce overdose risk by providing regulated, pharmaceutical-grade opioids to high-risk individuals. These programs began in Canada in 2017 and gained federal support in 2020.

Criticism and Opposition

Safer supply initiatives have faced criticism, particularly concerning potential for diversion and inadequate healthcare professional oversight. Concerns include the possibility of increased toxicity and overdose from insufficient supervision, and unequal care compared to other patients.

Clarifications and Comparisons

Safer supply programs are not addiction treatment. While they may involve medication, their primary goal is to reduce immediate overdose risk by replacing dangerous street drugs. They are seen as a crucial emergency intervention, similar to first aid, complementing, not replacing, treatment options. The limited reach and effectiveness of OAT highlight the need for safer supply programs.

Evidence

Emerging evidence suggests positive impacts from safer supply. Studies show reductions in non-fatal overdoses, emergency room visits, hospital admissions, and healthcare costs among participants. Qualitative data also indicate reduced illicit drug use and improved well-being.

Diversion

Diversion of safer supply drugs is a concern. While some programs report low diversion rates, more data are needed. Diversion's impact is complex, potentially creating both risks and benefits depending on how the diverted drugs are used. The potential for diversion shouldn't negate the benefits, but should be carefully managed through program design and regulation.

Nomenclature

The term "safe supply" is misleading. While safer than street drugs, these substances still carry risks. More accurate terminology is needed to avoid misrepresentation and polarization.

Conclusions

The ongoing drug death crisis demands effective solutions. Safer supply programs offer a potential, albeit controversial, emergency measure. Initial evidence suggests benefits, although further monitoring is essential. These programs should be judged by different standards than traditional addiction treatment, considering their crucial role in reducing immediate overdose risk, while acknowledging the risk of diversion. Until more effective alternatives emerge, safer supply programs remain a vital tool in addressing this crisis.

Summary

Canada and the U.S. have a big problem with people dying from drug overdoses. Many deaths are caused by strong, illegal drugs like fentanyl. In 2021, thousands of people died in Canada and many more in the U.S.

Safer Drug Supply

Doctors are trying new ways to help. One way is to give people safer drugs instead of the dangerous ones they usually use. This is like giving someone a safer way to smoke if they can’t quit. This helps reduce the risk of overdose. Canada started some small programs, and now the government supports them.

Criticism

Some people worry that giving out safer drugs might lead to problems, like people selling the drugs to others. They also think it might not be the best way to help people stop using drugs.

Clarifications

Safer drugs aren't a cure for addiction. They are like giving someone first aid at an accident scene – a way to save lives in an emergency. Many people who need help don't get it, so safer drugs are another way to keep them safe.

Evidence

Studies show that safer drug programs can help reduce overdoses and hospital visits. People in the programs also reported feeling better and using less of the illegal drugs.

Diversion

There's a concern that people might share the safer drugs. While this is a worry, it’s happening with other medicines, too. The benefit of saving lives might outweigh the risks of sharing. We need more research to understand how big of a problem it is.

What's in a Name?

The programs shouldn’t be called “safe supply” because the drugs can still be dangerous. Using a clearer name would help avoid misunderstandings.

Conclusions

We still don't have all the answers to this big drug problem. Safer drug programs are helping some people, but we need more information to know how well they work overall. They should be considered alongside other treatments to save lives.