Canadian researchers want to clarify the concepts related to safe opioid supply to better assess their impact and guide public-health policies.
In Canada, thousands of people use contaminated street opioids. To reduce overdoses, the country has been experimenting for the past 10 years with the distribution of pharmaceutical opioids as an alternative to illicit drugs.
This method is often referred to as "safe supply" or "safer supply."
What exactly do these terms, which emerged in the late 2010s and are central to Canadian harm reduction policies, mean?
In a study published in the International Journal of Drug Policy, a research team led by Université de Montréal professors Dr. Julie Bruneau and Sarah Larney provide some answers.
Two ways to define
With the help of the study's first author, Uyen Do, who was then a research officer in their team, the two researchers distinguished two clearly defined categories of approaches that are included in the "safe or safer supply" concept.
The first takes a medical approach (safer supply), and the other takes a community-based approach (safe supply), in which the safe supply, meaning substances that are tested for their content, is not supervised by health professionals.
Until now, these two approaches have often been lumped together under a single concept, even though there are significant differences between the two, the researchers say.
"We're proposing to clarify the definitions of each approach to guide clinical practice," said Bruneau, holder of a Canada Research Chair in addiction medicine.
"Our study establishes a practical framework for better describing care models, testing them and thus identifying the most promising approaches according to contexts, local realities and people's profiles," she said.
"It can also be used to determine which components of an existing or future program must be documented, so that the benefits and risks can be rigorously assessed."
A framework for changing policies
In their study, through a review of scientific literature and a concept analysis, the researchers uncover several limitations of current data: few longitudinal or experimental evaluations, insufficient characterization of target populations, a lack of information on unintended consequences such as diversion, and no analysis of implementation gaps between provinces.
"Overdose in Canada must not be treated as a temporary emergency," said Larney. "It requires a nuanced and structured response based on scientific evidence in a field where health, social and ethical issues are sometimes marked by controversy and emotion."
It's crucial for researchers that new approaches are well defined and documented so that they can be adapted and optimized during implementation and their impact measured, Bruneau added.
By so doing, there could be considerable clinical and social benefits, such as improved access to care, a decrease in overdoses and less stigmatization of people who use drugs, the researchers say.
Canada leads the way
Canada has demonstrated its ability to innovate in the fight against opioid overdoses, they point out: it is currently the only country to experiment with safe supply on a large scale.
"Now is the time to consolidate our leadership with more evidence," said Bruneau.
"Our study could serve as a springboard for positioning the country as a world leader in harm reduction and addiction treatment. It could also strengthen the legitimacy of public-health interventions in the eyes of political bodies and the general public."
The new study goes beyond ideological divisions to encourage research for practical and humane solutions to a crisis that has already claimed over 50,000 lives in Canada, she added.
Author: Bruno Geoffroy
