5. Modeling safer supply programs: a qualitative evaluation of three safer opioid supply program models in British Columbia, Canada

Three low-barrier safer supply models operate in British Columbia providing participants a daily dose of physician-prescribed hydromorphone tablets: 1) the service provider model is integrated within social/health services requiring participants to attend the locations to receive their medications; 2) the housing model is integrated within supportive housing through on-site nurse/staff-distributed medication; 3) the automated dispensing model distributes medications through four automated dispensing machines in the province. This presentation will explore how the implementation context and operating procedures shaped access to, and engagement with, these novel overdose-focused interventions.

In-depth qualitative interviews were conducted with people enrolled in various safer supply programs in BC, and over 100 hours of ethnographic fieldwork was conducted within and around two program sites. Data were analyzed thematically and focused on program implementation and operation, including barriers and facilitators to program uptake, access and engagement.

Participants identified a number of facilitators (a reliable source of opioids, co-location within existing services, user agency) and barriers (operating hours, dose, medication provided, location) to program access, uptake and engagement. our study demonstrates that greater user agency (i.e., being able to decide when, where, and how to take their hydromorphone) can enhance program engagement.

Safer opioid supply programs represent a promising intervention to address North America’s ongoing overdose crisis by providing people at high fatal overdose risk an alternative to the toxic drug supply. Our findings demonstrate the acceptability of these programs among people accessing illicit opioids, however lower-barrier design and operational features should be considered to improve uptake and engagement.

Disclosure of interest statement: This work was supported by the National Institutes of Health, the Canadian Institutes for Health Research, and Health Canada.