Kimberly Mitchell says she’s alive and contributing to her community thanks to the safer supply program at Parkdale Queen West Community Health Centre, one of 22 safer supply initiatives that as of March 31 are no longer receiving federal funding.
Mitchell says she fears the termination of the program will have catastrophic impacts. “It’s going to basically force people to say, ‘You know what? I’m going to go right into rehab or I’m just going back to the streets to get the unregulated drug supply and wait to die.’ ”
Ottawa’s Substance Use and Addictions Program (SUAP) provided time-limited federal funding for nearly 100 community-led organizations and nonprofits like the Parkdale Queen West Centre for a range of substance use prevention, harm reduction and treatment initiatives across the country.
The program will continue to fund projects that address substance use, however their 2023 national call for proposals did not say whether funding for safer supply programs would be a part of future federally-supported initiatives.
Studies show that 75 per cent of opioid overdose deaths in 2024 (between January and September) were linked to unregulated fentanyl from the unregulated drug market.
It’s clear that safer supply provides many benefits, says Gillian Kolla, assistant professor at Memorial University in Newfoundland. “We have a very healthy and robust evidence base in the medical and public health literature . . . developed in the last few years.”
Rebecca Penn, program manager of the National Safer Supply Community of Practice, says an added benefit of the SUAP safer supply programs was low-barrier access to primary care and other health and social wraparound services such as case management, referrals to other services and housing and employment supports.
SUAP projects also provided robust evaluation data as the funding terms required assessment of implementation, models and client outcomes.
A Health Canada spokesperson says the SUAP program was intended to provide time-limited funding “to test interventions prior to broader implementation … (and) was not designed to provide long-term or ongoing funding to projects or organizations.”
Penn says the hope was that the approach could be incorporated into the existing continuum of care and that provincial governments would take over funding of the programs. In 2020, the federal minister of health, Patty Hajdu, sent a letter to provincial and territorial governments encouraging them to remove barriers to implementing safer supply, especially during the COVID-19 pandemic.
Without additional funding from the province, Penn says staff are working to connect clients with addictions medicine providers to access other services including opioid agonist therapy.
Kolla says ending the safer supply programs will not only impact people relying on the services but also health-care costs in Ontario. “I think it’s very, very short sighted of the Ontario government not to continue funding for these programs because they had an established evidence base,” says Kolla. “They were reducing health-care costs, including emergency department visits and hospitalizations.”
Penn shares Kolla’s concerns. “We’re going to see a group of folks who are disconnected from care, and this is happening at the same time as the supervised consumption sites are closing as well.”
In addition to losing SUAP funding for its safe supply operations, Parkdale will also be impacted by the recent wave of attempted SCS closures implemented by the government of Ontario.
Parkdale is a community health centre that includes three locations, one of which is one of the nine centres Ontario will be transitioning to a Homelessness and Addiction Recovery Treatment (HART) Hub. The organization will receive up to four times as much money as they did under the previous provincial funding model, the province has said, but they will not be allowed to offer supervised consumption services. The HART Hubs are abstinence-based treatment models and also ban the distribution and collection of needles and other drug paraphernalia, and prohibits any new safer supply initiatives from being launched.
A safer supply program had significantly reduced rates of emergency department visits, hospitalizations for infectious complications and lower health-care costs.
Mitchell says being on safer supply allows her to focus on other aspects of life rather than the hustle of acquiring unregulated drugs. She now sits on a number of committees and works as a research assistant related to safer supply and harm reduction advocacy.
“I have my mom’s respect that I never thought I would ever get back,” says Mitchell.
Two population-level studies published since 2022, one in Ontario and one in B.C., showed reduced rates of opioid overdose-related deaths for those on safer supply.
Kolla co-authored the Ontario-based study that found those in a safer supply program also had significantly reduced rates of emergency department visits, hospitalizations for infectious complications and lower health-care costs.
In 2022, Health Canada funded an independent assessment of the first 10 SUAP safer supply pilot projects funded in 2020. It found that “almost all clients reported significant improvements to their lives” as a result of the safer supply and other health and social support services.
The next overall progress report from Health Canada was expected this winter but it has not been released yet. Penn says she is confident the results will be consistent with previous evaluations and research. “I think what we’ll see is that there have been lots of benefits that clients have accomplished … in this model of care.”
Despite evidence demonstrating the efficacy of these programs at reducing overdose-related death and other positive outcomes, safer supply programs have received criticism over concerns of diversion or the sharing, exchanging or selling of prescribed safer supply drugs with others not in the program.
These concerns have fed into broader backlash across the country against progressive drug policies that include harm reduction approaches. For example, a recent provincial policy change in B.C. now requires people to consume their hydromorphone doses under observation – something advocates say is untenable given that these doses are short-acting alternatives and may be required every few hours.
A 2023 Statistics Canada report highlights, “Despite recent rises in substance-related deaths, the prevalence of substance use disorders did not increase from 2012 to 2022.” In B.C., a 2023 report from the Office of the Provincial Health Officer noted the rate of opioid use disorder in youth under 19 years of age had remained “stable and low” since 2010 and new diagnoses among youth aged 19 to 25 years had decreased since 2017.
Penn says diversion is not a new concept. “We do know diversion happens. We’ve never pretended otherwise, and we have evidence and papers that talk about how it happens, why it happens, but we still don’t have an understanding of the scope.”
Mitchell says it’s not worth cancelling safer supply programs entirely because of some diversion. “[These programs] help all these people, you know, then now you’re still gonna rock their boat.”
Kolla says now is not the time to end services. Rather, a range of evidence-based treatment in addition to harm reduction options like safer supply and supervised consumption sites are needed.
“We’re still in the midst of an absolutely devastating overdose crisis, and it’s really one of those situations where we need all hands on deck and multiple different forms of options for people.”
Hi Emily, thanks for your article.
Safe supply (or as critics would call it Public Supply of Addictive Drugs) is still quite controversial and divisive and I think your article would be strengthened by the balance of an opposing perspective. Gillian Kolla, unfortunately, is incorrect in saying there is robust evidence for safe supply (and I worry is ideologically motivated). Most of these studies are qualitative (interviews) and quantitative studies are scarce and conflicting, for example (PMID 38227344) in BC showing safe supply is associated with a significant increase in opioid-related poisoning hospitalizations.
I appreciate you highlighting the concerns about diversion. One other key concern about safe supply that I’ve personally seen is that it often will subvert recovery oriented care. When you are trapped in the vicious cycle of addiction, in some cases limiting capacity to make substance-related decisions, I would argue (morally) its cruel to reinforce an individual’s suffering with safe supply. I understand the counter argument that its meant to keep them alive, but the proof is not in the pudding.
Personally, you could try and read Kimberly’s story and not negate her experience. Dr Kolla’s work is important and peer reviewed. In a time of toxic drugs and the constant addition of drugs to the illicit supply, stabilizing someone on OAT has become much harder. Safe supply can be that stepping stone to stabilization as people know what they are taking. We need to hear more from the people who have direct experience from it and not less. What’s killing people is largely the tainted illicit drug supply. I wish those who comment about the evils of safe supply actually discussed what drugs people are accessing from underground drug market which harms people in so many ways and not just go after safe supply. How about we just let people talk about their positive experience without having to constantly hear that it’s bad.
Thank you so much for the comment. It is very appreciated. I know there’s a lot of people out there that really care and yes it is a stepping stone to get to a better place and when you’re both mentally and physically addicted to something you have to be able to conquer one thing at a time. With Safer Supply it allows you to be stable with the physical end of things and then you can work on other things like housing, employment, and other things that you wouldn’t normally be able to deal with if you were constantly chasing after the street drugs which are poisoning everybody. I find it hard to believe that they have case studies where the death rate would increase because of the drugs received on Safer Supply as they are medications that you pick up at the pharmacy so you know what’s in it.
I must have missed when this website was renamed from “healthydebate.ca” to “echochamber.ca” ;) Must we split me into a negating, malevolent moral-prude who demeans researchers and vilifies safe supply from my detached inexperience? I believe we both earnestly care (at least I do) in terms of helping people suffering and dying with addiction, but disagree about how to help.
I can recognize that Kimberly’s lived experience is real and serves as a useful anecdote for understanding this complex issue, AND at the same time contribute to the discussion with a counterpoint (which I feel is lacking from this article, which is especially important as this article is strongly advocating for this policy without this nuance!)
I agree, Gillian Kola’s research is important and peer reviewed, but that should not shield it from nuanced discussion and perhaps even criticism. In any case, I am criticizing her sweeping generalization that the landscape of evidence for safe supply is “robust” when there is clear contradictory evidence (as I linked) and overall scarcity of quantitative evidence.
Anecdotes (while moving) and sweeping generalizations may undermine that there are real concerns about the safety of safe supply that need to be explored, especially as this piece advocates for safe supply policy. Its not fully clear based on current research if safe supply (beyond low quality qualitative interviews and anecdotes) overall stabilizes, reduces mortality, reduces illicit use, and we definitely have a poor grasp of the harms like diversion and societal ills.
This discussion feels akin to anecdotal experience that thalidomide is incredibly stabilizing for morning sickness, and any non-pregnant nay-sayers are haters when they inquire about evidence of benefits and concerns about risk.
That Nguyen et al study has a lot of methodological issues. JP, I suggest reading the multiple other studies that use a variety of methodologies and data sources, including health administrative data, rather than referring to one recently published article that will no doubt receive a lot of criticism for its poor methodology and weak interpretation of its flawed analysis. Further, you are relying on anecdote when you say that it subvert recovery oriented care. If you were to listen to Kimberly’s story, and the many others, you would see how safer supply has not just prevented deaths, but also repaired relationships with healthcare providers, increased physical and mental health, reduced engagement in criminalized activities, increased engagement in social services, facilitated employment, improved social and familial relationships, and so much more.