Challenges of implementing safer supply programs in Canada during the COVID-19 pandemic: A qualitative analysis

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dc.contributor.authorKaramouzian, Mohammad
dc.contributor.authorRafat, Bijan
dc.contributor.authorKolla, Gillian
dc.contributor.authorUrbanoski, Karen
dc.contributor.authorAtkinson, Kate
dc.contributor.authorBardwell, Geoff
dc.contributor.authorBonn, Matthew
dc.contributor.authorTouesnard, Natasha
dc.contributor.authorHenderson, Nancy
dc.contributor.authorBowles, Jeanette
dc.contributor.authorBoyd, Jade
dc.contributor.authorBrunelle, Caroline
dc.contributor.authorEeuwes, Jolene
dc.contributor.authorFikowski, Jill
dc.contributor.authorGomes, Tara
dc.contributor.authorGuta, Adrian
dc.contributor.authorHyshka, Elaine
dc.contributor.authorIvsins, Andrew
dc.contributor.authorKennedy, Mary Clare
dc.contributor.authorLaurence, Gab
dc.contributor.authorMartignetti, Lucas
dc.contributor.authorNafeh, Frishta
dc.contributor.authorSalters, Kate
dc.contributor.authorTu, David
dc.contributor.authorStrike, Carol
dc.contributor.authorPauly, Bernie
dc.contributor.authorWerb, Dan
dc.date.accessioned2025-03-18T16:02:05Z
dc.date.available2025-03-18T16:02:05Z
dc.date.issued2023
dc.description.abstractBackground Canada is experiencing an unprecedented drug toxicity crisis driven by a highly toxic unregulated drug supply contaminated with fentanyl, benzodiazepine, and other drugs. Safer supply pilot programs provide prescribed doses of pharmaceutical alternatives to individuals accessing the unregulated drug supply and have been implemented to prevent overdose and reduce related harms. Given the recent emergence of these pilot programs and the paucity of data on implementation challenges, we sought to document challenges in their initial implementation phase. Methods We obtained organizational progress reports from Health Canada, submitted between 2020 and 2022 by 11 pilot programs located in British Columbia, Ontario, and New Brunswick. We analyzed the data using deductive and inductive approaches via thematic analysis. Analyses were informed by the consolidated framework for implementation research. Results We obtained 45 progress reports from 11 pilot programs. Six centres were based in British Columbia, four in Ontario, and one in New Brunswick. Four overarching themes were identified regarding the challenges faced during the establishment and implementation of pilot programs: i) Organizational features (e.g., physical space constraints, staff shortages); ii) Outer contexts (e.g., limited operational funds and resources, structural inequities to access, public perceptions); iii) Intervention characteristics (e.g., clients’ unmet medication needs); and iv) Implementation process (e.g., pandemic-related challenges, overly medicalized and high-barrier safer supply models). Conclusions Safer supply pilot programs in Canada face multiple inner and outer implementation challenges. Given the potential role of safer supply programs in addressing the drug toxicity crisis in Canada and the possibility of future scale-up, services should be well-supported during their implementation phases. Refining service provision within safer supply programs based on the feedback and experiences of clients and program administrators is warranted, along with efforts to ensure that appropriate medications are available to meet the clients’ needs.
dc.description.sponsorshipThis study was funded by the Canadian Institutes of Health Research (reference number: EV1-174804).
dc.identifier.citationKaramouzian, M., Rafat, B., Kolla, G., Urbanoski, K., Atkinson, K., Bardwell, G., Bonn, M., Touesnard, N., Henderson, N., Bowles, J., Boyd, J., Brunelle, C., Eeuwes, J., Fikowski, J., Gomes, T., Guta, A., Hyshka, E., Ivsins, A., Kennedy, M. C., . . . Werb, D. (2023). Challenges of implementing safer supply programs in Canada during the COVID-19 pandemic: A qualitative analysis. International Journal of Drug Policy, 120, 104157. https://doi.org/10.1016/j.drugpo.2023.104157
dc.identifier.urihttps://doi.org/10.1016/j.drugpo.2023.104157
dc.identifier.urihttps://hdl.handle.net/1828/21665
dc.language.isoen
dc.publisherInternational Journal of Drug Policy
dc.rightsCC BY-NC 4.0
dc.rights.urihttp://creativecommons.org/licenses/by-nc/4.0/
dc.subjectHarm reduction
dc.subjectCanada
dc.subjectoverdose
dc.subjectsafer supply
dc.subjectopioids
dc.titleChallenges of implementing safer supply programs in Canada during the COVID-19 pandemic: A qualitative analysis
dc.typeArticle

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