The Safer Alternatives for Emergency Response (SAFER) program provides a safe supply of substances to prevent drug overdose deaths, according to a new report.
The program has been operating in Vancouver, British Columbia, since April 2021. So far, the program has enrolled 58 participants who have reported benefits from having new options when other forms of treatment or harm reduction didn’t work. In addition, doctors who work with the program have reported increased medication adherence among the participants, as well as better chronic disease management.
Similar safe supply programs are being implemented or considered in other places across Canada. Since 2019, Health Canada has funded 18 safe supply pilot programs.
“When we look at the number of overdose deaths, it should be zero. These are preventable deaths,” author Christy Sutherland, MD, medical director at the PHS Community Services Society, Vancouver, which operates the SAFER program, told this news organization.
PHS Community Services Society
Dr. Christy Sutherland
“As clinicians, we can see that the tools we have are working less because of prohibition. It drives the market to provide more potent and more dangerous options,” she said. “It’s critical that we disrupt the illicit market and provide medical solutions to keep people safe.”
The report was published in the Canadian Medical Association Journal.
Safe supply programs
Between January 2016 and June 2021, more than 24,000 people died from opioid toxicity in Canada, according to the authors. A key driver of the ongoing public health crisis has been the introduction of illicit fentanyl and other dangerous substances into the unregulated drug supply.
In recent years, several harm-reduction options and substance use disorder treatment programs have been introduced in Canada to stem overdose deaths. However, they haven’t been sufficient, and the number of deaths continues to rise.
“In 2010, methadone worked, but now even high doses don’t keep people out of withdrawal due to the infiltration of fentanyl,” Dr. Sutherland said. “It’s clinically not working anymore. People are now going through benzodiazepine withdrawal and opiate withdrawal at the same time.”
The changes have led doctors to call for programs that provide legal and regulated sources of psychoactive substances, also known as “safe supply” programs. In particular, low-barrier and flexible options are necessary to meet the needs of various people in the community.
In Vancouver, the SAFER program provides medications that are prescribed off-label as substitutes to the illicit drug supply. A multidisciplinary team oversees the program, including doctors, nurses, pharmacists, social workers, and people who have experience living with substance use.
The program’s approach is akin to the use of medications as treatments for substance use disorder, such as opioid-agonist therapy. However,
Enrolled participants can access medications, including opioids such as hydromorphone and fentanyl, as a substitute for the unregulated substances that they consume. A notable aspect of SAFER is the offer of fentanyl – with a known potency and without dangerous adulterants found in the local drug supply.