Prescribed safer supply during dual public health emergencies: a qualitative study examining service providers perspectives on early implementation

Background: Over the past decade, drug-related overdoses have seen a significant rise both in North America and globally. The COVID-19 pandemic has further emphasised the urgent need for safer supply programs to replace unregulated substances, reducing toxicity and overdose risks. Service providers play a crucial role in delivering safer supply initiatives, yet there's limited empirical evidence from their perspective on what constitutes effective safer supply programs. This study delves into the initial implementation and impacts of a safer supply program, capturing insights from an interdisciplinary team of service providers involved in the development of the SAFER program.

Methods: Employing a community-based participatory approach, individual interviews were conducted with program providers (n = 9). The research team consisted of members from a local drug user organisation, a harm reduction organisation, and academic researchers. The Consolidated Framework for Implementation Research (CFIR) guided the interview process, and thematic analysis was used to analyse the data.

Results: Six key themes emerged from the early implementation phase:

1. Context of risk mitigation prescribing
2. Development of SAFER-specific clinical protocols
3. Challenges in accessibility and program innovations
4. Interdisciplinary teamwork and wraparound care
5. Tensions between addiction medicine and harm reduction approaches
6. Successes of safer supply and future aspirations

Conclusion: Early implementation challenges and tensions included prescriber concerns in a politicised environment, accessibility hurdles for service users (such as stigma, displacement, and program costs), and navigating tensions between addiction medicine and harm reduction philosophies. Addressing these challenges involved developing clinical protocols, innovative approaches to improve accessibility, providing wraparound care, and addressing medication costs. These insights offer valuable guidance for the development of prescribed safer supply programs.