4. A sea of need – Safe opioid supply service provider accounts of implementing admission priorities

Safer opioid supply programs (SSPs), state sanctioned and currently being piloted in Canada, are a strategy to reduce the opioid overdose crisis claiming 1000s of lives each year. SSPs provide individuals who use illicit opioids with an 'off label' prescription for pharmaceutical-grade opioids. We explore service provider challenges in implementing admission priorities.

During 2021, we conducted short demographic and semi-structured interviews with healthcare providers from four SSPs in Ontario about implementation, challenges, and impacts. Thematic analysis was conducted in MAXQDA and descriptive statistics in SPSSv28.

Participants (n=27; prescribing physicians and nurse practitioners; nurses, allied professionals, pharmacists) spoke about prioritizing for admission clients at the highest risk for imminent harm: refractory for opioid agonist treatment; frequent opioid overdose; identified as women, LGBTQ, Black, Indigenous or a person of colour; engaged in sex work; living with unmanaged HIV/HCV; and palliative. Despite focussed criteria, implementation and scale up of SSPs occurred during the pandemic and escalation of overdoses. Healthcare providers struggled to meet demand for admissions and related ethical challenges. Iterative attempts to address demand included trialing new intake procedures and waitlists and restricting eligibility to higher risk clients with complex physical and mental health co-morbidities, and housing insecurity. Focussing on the most marginalized slowed admissions but increased pressure on severely stretched primary care resources.

Findings indicate a need to radically expand the number of, and access to, SSPs and to pursue additional clinical and policy options to respond to the ever-increasing magnitude of the opioid overdose crisis.

Disclosure of interest statement: This work was supported by the Ontario HIV Treatment Network