by millie schulz
The National Safer Supply Community of Practice (NSS-CoP) is a new knowledge exchange initiative led by London InterCommunity Health Centre, in partnership with the Canadian Association of People who Use Drugs, the Ontario Aboriginal HIV/AIDS Strategy, and the Alliance for Healthier Communities. Its goal is to scale up safer supply programs across Canada.
This Community of Practice has been created with the intention of supporting healthcare and social service providers as they provide care for clients using opioids and at risk for overdosing. As the need continues to grow for safer supply, this Community of Practice will serve as a resource for those who would benefit from learning about how to deliver care within this framework. However, this is not a teaching space - but rather a space where healthcare and social service providers and people with lived experience exchange information, including clinical experiences, program operational experiences, and client experiences.
Our work is grounded in an anti-oppression and anti-racism framework and anchored on core values of dignity, inclusion, community, social justice, courage, persistence and hope.
What is Safer Supply?
In 2020, Health Canada began funding Safer Supply programs as one approach to addressing the drug poisoning crisis.
Safer Supply is a harm reduction driven, public health approach that involves the provision of a pharmaceutical drug supply of known quantity and quality to adults who use illegal drugs and who are at high risk of overdose and other harms. Calls for a safer supply of drugs are not new, and people who use(d) drugs and healthcare professionals have been engaged in this work for some time now.
There are different models for Safer Supply. A medical model makes use of regulated health professionals’ ability to prescribe pharmaceutical drugs. It encompasses iOAT, TiOAT, vending machine, and daily dispensed tablet programs. A medical model can be implemented in different ways, drawing on different approaches such as a ‘treatment’ focus or a ‘harm reduction’ focus.
For more information about different models of safer supply, please see CAPUD’s Safe Supply Concept Document and our evidence brief.
Why Safer and not Safe?
You may have noticed that we use the term “safer supply” as opposed to “safe supply”. There are several reasons for this positioning.
Most importantly, medicalized approaches to safer supply are only “safer” right now because the guidelines and policies of current programs (including dosages and protocols) do not adequately or appropriately address the expressed needs of people who use drugs who are accessing these programs. Because these guidelines do not adequately address these expressed needs, people who use drugs must rely on toxic drug supplies to get what they need in order to feel well, putting them at risk of drug-poisoning and overdose. Ultimately, the term “Safe Supply” came from activist groups of people who use drugs and the medical model is simply not what they were referring to and envisioning in their demands for “Safe Supply”.
In addition to this, Health Canada and many of the programs providing hydromorphone prescription options refer to these programs as “safer supply” given that the use of opioids always comes with some risks and so cannot be called “safe”, while also acknowledging that a drug that is of known quality, composition, and potency is safer than drugs purchased on the street from an unregulated market.
Safer Supply Guiding Principles
People who use drugs are experts
People who use drugs are knowledgeable about the culture of drug use and their own goals and needs. Collaborating with people who use drugs is critical to developing successful programs and strategies to address the overdose crisis. Their expertise should guide the development, implementation, and evaluation of Safer Supply programs.
Participant-led and participant-centred care delivery
The program will aim to support people to meet their current goals for drug use in the safest way possible. Our aim is to provide compassionate and equitable health care to people who use drugs.
Harm reduction
The program recognizes that drug-related harms stem from several different sources, including from criminalization. It aims to reduce some of the harms associated with drug use by providing a safer drug supply. Clinicians will respect people’s autonomy and choices around drug use and accessing healthcare.
Low-barrier care
The program is meant to be as accessible as possible. Clinicians will strive to meet participant needs and ensure access to care through flexibility, problem solving and collaboration.
Non-punitive approach
Missed doses or assessments or continued illicit drug use will be addressed through dialogue and support and will not result in discharge from the program.
Supporting Safer Supply
The NSS-CoP focuses on a medical model rooted in harm reduction because it is most feasible to quickly scale up in the current legislative and regulatory context. Tensions between harm reduction and a medical model create challenges, but together we strive to promote a medical model that is client-centred, lower-barrier, and centres people who use drugs as experts and creates space for them to be leaders and service providers. We are committed to supporting and engaging in advocacy for non-medical models of Safer Supply, decriminalization, and regulation.
Land Acknowledgement
We come together in this community of practice from across Turtle Island, as people who live on treaty lands and unceded territories. We work in a sector whose goal is to address social harms, and we must recognize that the production of these harms comes from the history of colonialism and its enduring practices, institutions, and ways of thinking.
Colonialism is with us today, and we must commit to working in ways that reshape these institutions and practices, to repair harms, and prevent future harms, to work towards a more inclusive and just future.
