Theme: Epidemiology & Public Health Research Year: 2024
Background: Providing pharmaceutical-grade medications as alternatives to the unregulated drug market (i.e., safer supply) has emerged as a harm reduction strategy in response to elevated overdose mortality in Canada. The principles and implementation of this approach can vary widely. We aimed to summarize the literature and describe models of safer supply for people who use drugs.
Methods: We searched five databases for peer-reviewed and grey literature on the provision of safer supply. We extracted intervention characteristics, including delivery setting, medications offered, intended population, and outcomes assessed. Using Walker and Avant’s concept analysis methodology, we extracted unique attributes from definitions of safer supply in the literature. Intervention characteristics and unique attributes were thematically organized into dimensions, leading to a framework that clarifies boundaries between the different models of safer supply. We also conducted risk of bias (ROB) assessment using tools appropriate for each study design.
Results: We included 234 articles: 167 (71%) empirical and 67 (29%) non-empirical (i.e., perspectives, commentaries). Of the empirical articles, 117 (70%) evaluated alternative opioid agonist treatments (essentially injectable opioid agonist treatments), 42 (25%) evaluated harm reduction-oriented substance use management (e.g., standard OAT with short-acting opioids), and 8 (5%) evaluated harm reduction strategies (e.g., fentanyl patch, vending machine, buyers’ club). Characteristics and attributes of the safer supply interventions were grouped into the following dimensions: 1) Philosophy of care, 2) Indications for prescribing, 3) Intervention protocol, 4) Accessibility points, and 5) Continuity of care (i.e., wrap-around healthcare services). ROB assessment reveals heterogenous ratings across empirical works and clinical guidance documents.
Conclusion: This work on safer supply facilitates a nuanced understanding of the various dimensions and implications surrounding the philosophy of care and delivery of safer supply, a needed step toward the integration of this promising strategy into future evidence-based research strategies, guidelines, and policy decisions on substance use management.
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