Challenges of implementing safer supply programs in Canada during the COVID-19 pandemic: A qualitative analysis.

Canada Harm reduction Opioids Overdose Safer supply

Journal

The International journal on drug policy
ISSN: 1873-4758
Titre abrégé: Int J Drug Policy
Pays: Netherlands
ID NLM: 9014759

Informations de publication

Date de publication:
Oct 2023
Historique:
received: 24 02 2023
revised: 28 07 2023
accepted: 31 07 2023
pubmed: 14 8 2023
medline: 14 8 2023
entrez: 14 8 2023
Statut: ppublish

Résumé

Canada is experiencing an unprecedented drug toxicity crisis driven by a highly toxic unregulated drug supply contaminated with fentanyl, benzodiazepine, and other drugs. Safer supply pilot programs provide prescribed doses of pharmaceutical alternatives to individuals accessing the unregulated drug supply and have been implemented to prevent overdose and reduce related harms. Given the recent emergence of these pilot programs and the paucity of data on implementation challenges, we sought to document challenges in their initial implementation phase. We obtained organizational progress reports from Health Canada, submitted between 2020 and 2022 by 11 pilot programs located in British Columbia, Ontario, and New Brunswick. We analyzed the data using deductive and inductive approaches via thematic analysis. Analyses were informed by the consolidated framework for implementation research. We obtained 45 progress reports from 11 pilot programs. Six centres were based in British Columbia, four in Ontario, and one in New Brunswick. Four overarching themes were identified regarding the challenges faced during the establishment and implementation of pilot programs: i) Organizational features (e.g., physical space constraints, staff shortages); ii) Outer contexts (e.g., limited operational funds and resources, structural inequities to access, public perceptions); iii) Intervention characteristics (e.g., clients' unmet medication needs); and iv) Implementation process (e.g., pandemic-related challenges, overly medicalized and high-barrier safer supply models). Safer supply pilot programs in Canada face multiple inner and outer implementation challenges. Given the potential role of safer supply programs in addressing the drug toxicity crisis in Canada and the possibility of future scale-up, services should be well-supported during their implementation phases. Refining service provision within safer supply programs based on the feedback and experiences of clients and program administrators is warranted, along with efforts to ensure that appropriate medications are available to meet the clients' needs.

Sections du résumé

BACKGROUND BACKGROUND
Canada is experiencing an unprecedented drug toxicity crisis driven by a highly toxic unregulated drug supply contaminated with fentanyl, benzodiazepine, and other drugs. Safer supply pilot programs provide prescribed doses of pharmaceutical alternatives to individuals accessing the unregulated drug supply and have been implemented to prevent overdose and reduce related harms. Given the recent emergence of these pilot programs and the paucity of data on implementation challenges, we sought to document challenges in their initial implementation phase.
METHODS METHODS
We obtained organizational progress reports from Health Canada, submitted between 2020 and 2022 by 11 pilot programs located in British Columbia, Ontario, and New Brunswick. We analyzed the data using deductive and inductive approaches via thematic analysis. Analyses were informed by the consolidated framework for implementation research.
RESULTS RESULTS
We obtained 45 progress reports from 11 pilot programs. Six centres were based in British Columbia, four in Ontario, and one in New Brunswick. Four overarching themes were identified regarding the challenges faced during the establishment and implementation of pilot programs: i) Organizational features (e.g., physical space constraints, staff shortages); ii) Outer contexts (e.g., limited operational funds and resources, structural inequities to access, public perceptions); iii) Intervention characteristics (e.g., clients' unmet medication needs); and iv) Implementation process (e.g., pandemic-related challenges, overly medicalized and high-barrier safer supply models).
CONCLUSIONS CONCLUSIONS
Safer supply pilot programs in Canada face multiple inner and outer implementation challenges. Given the potential role of safer supply programs in addressing the drug toxicity crisis in Canada and the possibility of future scale-up, services should be well-supported during their implementation phases. Refining service provision within safer supply programs based on the feedback and experiences of clients and program administrators is warranted, along with efforts to ensure that appropriate medications are available to meet the clients' needs.

Identifiants

DOI: 10.1016/j.drugpo.2023.104157 PMID: 37574645
pubmed: 37574645
pii: S0955-3959(23)00204-9
doi: 10.1016/j.drugpo.2023.104157
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

104157

Informations de copyright

Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: KA and NH are employed by one of the pilot programs under evaluation. MB reports personal fees from AbbVie and grants and personal fees from Gilead Sciences, outside of the submitted work. MB and NT have also worked for the Canadian Association of People Who Use Drugs which receives funds from Health Canada. Other authors declare no have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Auteurs

Mohammad Karamouzian (M)

Centre on Drug Policy Evaluation, MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.

Bijan Rafat (B)

Centre on Drug Policy Evaluation, MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada.

Gillian Kolla (G)

Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC, Canada.

Karen Urbanoski (K)

Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC, Canada.

Kate Atkinson (K)

Parkdale Queen West Community Health Centre, Toronto, ON, Canada.

Geoff Bardwell (G)

School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada; British Columbia Centre on Substance Use, Vancouver, BC, Canada.

Matthew Bonn (M)

Canadian Association of People Who Use Drugs, Dartmouth, NS, Canada.

Natasha Touesnard (N)

Canadian Association of People Who Use Drugs, Dartmouth, NS, Canada.

Nancy Henderson (N)

Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC, Canada; Peterborough 360 Degree Nurse Practitioner-Led Clinic, Peterborough, ON, Canada.

Jeanette Bowles (J)

British Columbia Centre on Substance Use, Vancouver, BC, Canada.

Jade Boyd (J)

British Columbia Centre on Substance Use, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada.

Caroline Brunelle (C)

Department of Psychology, University of New Brunswick-Saint John campus, Saint John, NB, Canada.

Jolene Eeuwes (J)

Centre on Drug Policy Evaluation, MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada.

Jill Fikowski (J)

Changemark Research + Evaluation, Vancouver, BC, Canada.

Tara Gomes (T)

Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.

Adrian Guta (A)

School of Social Work, University of Windsor, Windsor, ON, Canada.

Elaine Hyshka (E)

School of Public Health, University of Alberta, Alberta, AB, Canada.

Andrew Ivsins (A)

British Columbia Centre on Substance Use, Vancouver, BC, Canada.

Mary Clare Kennedy (MC)

British Columbia Centre on Substance Use, Vancouver, BC, Canada; School of Social Work, University of British Columbia (Okanagan Campus), BC, Canada.

Gab Laurence (G)

Parkdale Queen West Community Health Centre, Toronto, ON, Canada.

Lucas Martignetti (L)

Centre on Drug Policy Evaluation, MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada.

Frishta Nafeh (F)

Centre on Drug Policy Evaluation, MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada.

Kate Salters (K)

British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.

David Tu (D)

Department of Family Practice, University of British Columbia, Vancouver, BC, Canada; Kilala Lelum, Urban Indigenous Health and Healing Co-operative, Vancouver, BC, Canada.

Carol Strike (C)

Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.

Bernadette Pauly (B)

Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC, Canada.

Dan Werb (D)

Centre on Drug Policy Evaluation, MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. Electronic address: daniel.werb@unityhealth.to.

Classifications MeSH