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.authoret al.
dc.date.accessioned2023-12-18T23:57:51Z
dc.date.available2023-12-18T23:57:51Z
dc.date.copyright2023en_US
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.en_US
dc.description.reviewstatusRevieweden_US
dc.description.scholarlevelFacultyen_US
dc.description.sponsorshipThis study was funded by the Canadian Institutes of Health Research (reference number: EV1-174804).en_US
dc.identifier.citationKaramouzian, M., Rafat, B., Kolla, G., Urbanoski, K., Atkinson, K., Bardwell, G., ... 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.2023.104157en_US
dc.identifier.urihttps://doi.org/10.1016/j.drugpo.2023.104157
dc.identifier.urihttp://hdl.handle.net/1828/15730
dc.language.isoenen_US
dc.publisherInternational Journal of Drug Policyen_US
dc.subjectCanada
dc.subjectHarm reduction
dc.subjectOpioids
dc.subjectOverdose
dc.subjectSafer supply
dc.subjectCanadian Institute for Substance Use Research (CISUR)
dc.subject.departmentSchool of Nursing
dc.titleChallenges of implementing safer supply programs in Canada during the COVID-19 pandemic: A qualitative analysisen_US
dc.typeArticleen_US

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