Possible benefits of providing safe supply of substances to people who use drugs during public health emergencies such as the COVID-19 pandemic

Key take-home messages

• Safe supply is an approach that focuses on saving lives by prescribing pharmaceutical grade substances such as opioids and stimulants to individuals at risk of overdose and does not include substitution or opioid agonist treatments, such as methadone, buprenorphine/suboxone, or slow release oral morphine, as these therapies do not contain the mind/body altering properties that people seek in recreational drugs.
•  Safe supply initiatives have begun in Canadian cities including Toronto, London and Ottawa without any overdose related deaths, and Vancouver has begun a pilot program that dispenses prescribed hydromorphone (Dilaudid) tablets.
•  We found no peer-reviewed literature regarding the potential benefits or harms of safe supply programs. However, we did find some evidence related to substitution treatments. Clinical trials that compared slow release oral morphine to methadone found that those in the slow release oral morphine group had: fewer heroin cravings, a statistically significant improvement in mental symptoms and treatment satisfaction, and similar retention rates and safety outcomes as the methadone treatment group.
•  Canadian clinical trials have found that among severe opioid dependent users, injectable diacetylmorphine (pharmaceutical heroin) was more effective in retaining participants and reducing rates of illicit drug use or other illegal activity than methadone. Hydromorphone is as effective as diacetylmorphine for subgroups of individuals with severe opioid use disorder, indicating that these treatments may be effective for patients who are resistant to or unsuccessful with other types of treatment.
• There is a call for efforts to address safe supply needs through pharmacological stimulant-based interventions that provide larger doses with greater frequency with methylphenidate and extended-release amphetamines as potential treatment candidates.

• Population(s)
  • People who use drugs
  • General HIV+ population
  • General HIV- population
• Prevention
  • Drug use behaviours/harm reduction
• Substance Use
  • Nonmedicinal drugs
• Co-infections
  • Other
• Health Systems
  • Delivery arrangements