Risk mitigation guidance and safer supply prescribing among young people who use drugs in the context of COVID-19 and overdose emergencies

Giang, Karen; Charlesworth, Reith; Thulien, Madison; Mulholland, Alanna; Barker, Brittany; Brar, Rupinder; Pauly, Bernie; Fast, Danya

doi:10.1016/j.drugpo.2023.104023

Cited by 14 publications

(1 citation statement)

References 60 publications

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“…These contrasting experiences with medicalization and structure point to the need to implement alternative, innovative models of safer supply that would allow participants to have agency and autonomy over their lives. This could include looking at options for non-prescribed safer supply models, such as compassion clubs, where participants can access their safer supply without needing a prescription [28,33,[35][36][37][38].…”

Section: Discussionmentioning

confidence: 99%

“And this is the life jacket, the lifeline they’ve been wanting”: Participant perspectives on navigating challenges and successes of prescribed safer supply

Henderson,

Marris,

Woodend

2024

PLoS ONE

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Background In 2021, 43% of drug toxicity deaths in Ontario were reported by public health units serving medium-sized urban and rural communities. Safer supply programs (SSPs) have been primarily established in large urban centres. Given this, the current study is based on an evaluation of a SSP based in a medium-sized urban centre with a large catchment area that includes rural and Indigenous communities. The aim of this research paper is to understand the challenges and successes of the nurse practitioner-led SSP from the perspective of program participants. Methods Interpretive description was used to understand the experiences of 14 participants accessing a SSP. Each participant was interviewed using a semi-structured approach, and 13 of the interviewees also completed surveys accessed through Qualtrics. An iterative process using NVivo software was used to code interviews, and a constant comparative data analysis approach was used to refine and categorize codes to themes. Findings Three overarching themes were the result of this analysis: feeling better, renewed hope, and safety. These three themes capture the experiences of participants in the SSP, including both the challenges and successes they faced. Conclusion The findings and subsequent discussion focus on both the key best practices of the program, and areas for future development and improvement. Despite barriers to services, prescribed SSPs are improving the lives of people who use drugs, and the current outcomes align with reports and evaluations from other SSPs across Canada.

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Section: Discussionmentioning

confidence: 99%

“And this is the life jacket, the lifeline they’ve been wanting”: Participant perspectives on navigating challenges and successes of prescribed safer supply

Henderson,

Marris,

Woodend

2024

PLoS ONE

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Perspectives on Diversion of Medications From Safer Opioid Supply Programs

Olding,

Rudzinski,

Schmidt

et al. 2024

JAMA Netw Open

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ImportanceSafer supply programs were implemented in Canada to provide pharmaceutical-grade alternatives to the toxic unregulated drug supply. While research shows clinical benefits and reduced overdose mortality among safer supply patients, medication diversion remains a concern.ObjectiveTo examine provider (prescribing clinicians and allied health professionals) and patient perspectives on diversion of opioids prescribed in safer supply programs.Design, Setting, and ParticipantsIn 2021, qualitative interviews and sociodemographic questionnaires were conducted with patients and providers across 4 safer supply programs in Ontario, Canada. Interviews with 21 providers (physicians, nurse practitioners, and allied health professionals) and 52 patients examined experiences implementing safer supply or receiving care. Initial data analysis was conducted from December 2021 to March 2022, and the subanalysis focused on diversion was conducted from December 2023 to March 2024.ExposuresParticipation in safer supply program as a patient or provider.Main Outcomes and MeasuresData about diversion were coded, extracted, and thematically analyzed.ResultsOf 52 patient participants, 29 (55.8%) were men and 23 (44.2%) were women; 1 was Black (1.9%), 9 (17.3%) were Indigenous, 1 was Latino (1.9%), and 41 (78.8%) were White; and the mean (SD) age was 46.5 (9.6) years. Of 21 provider participants, 6 (28.6%) were men, 13 (61.9%) were women, and 2 (9.5%) were nonbinary; and the mean (SD) age was 37.6 (7.6) years. Participants characterized diversion as a spectrum ranging from no diversion, to occasional medication sharing and loss, to selling all prescribed doses of safer supply (considered rare and easy to detect). Most patients reported they consumed all or most of their prescribed medications and rarely shared or sold their doses. However, providers and patient participants shared that people might share, trade, and/or sell some of their medications with other opioid-using people for multiple reasons. Most prominent reasons for diversion were (1) compassionate sharing with intimate partners and friends to manage withdrawal and overdose risk; (2) selling or trading medications to address their own unmet substance use needs (eg, high opioid tolerance); and (3) medication loss due to poverty, homelessness, and associated vulnerabilities to theft and coercion. Programs used nonpunitive urine drug screening practices and patient self-report to monitor medication use. When diversion was identified, providers described using nonjudgmental conversations to understand patients’ needs and develop mitigation strategies that addressed underlying reasons for diversion, including changing doses and medications prescribed to better match patients’ needs, enrolling eligible intimate partners, and developing safety plans to mitigate vulnerabilities to theft and coercion.Conclusions and RelevanceDiversion encompasses a wide spectrum of practices (selling, sharing, and loss of medications), and occurs for complex reasons that surveillance and punitive measures are unlikely to mitigate. Diversion may be best addressed by expanding medication options to better match patients’ diverse substance use needs and high tolerance, alongside wraparound social supports.

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Clinicians’ Perspectives and an Ethical Analysis of Safer Supply Opioid Prescribing

Bird,

Genuis,

Ickowicz

2024

Bioethical Inquiry

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Risk mitigation guidance and safer supply prescribing among young people who use drugs in the context of COVID-19 and overdose emergencies

Cited by 14 publications

References 60 publications

“And this is the life jacket, the lifeline they’ve been wanting”: Participant perspectives on navigating challenges and successes of prescribed safer supply

“And this is the life jacket, the lifeline they’ve been wanting”: Participant perspectives on navigating challenges and successes of prescribed safer supply

Perspectives on Diversion of Medications From Safer Opioid Supply Programs

Clinicians’ Perspectives and an Ethical Analysis of Safer Supply Opioid Prescribing

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