This report presents an updated overview of the Safer Supply Ottawa program as well as the results of a program evaluation conducted in the summer of 2023. A mixed methods study encompassing interviews and surveys with Safer Supply participants was performed to understand their experiences within the program. During this program evaluation, a focus was taken on program participants who are frequently "restarted" on their Safer Supply program. Program restarts included participants who have stopped and subsequently restarted their Safer Supply program one or more times in the last year. This topic was selected to better understand the barriers faced by Safer Supply participants when engaging in their program, including barriers which result in these program interruptions. Participants also spoke extensively about medication diversion and the importance of understanding the different reasons why diversion occurs, including safety, compassion, meeting needs, survival, and pressure.

This report provides an updated overview of the 3 existing Safer Supply programs in Ottawa as well as a more in-depth exploration of Safer Stimulant Supply programs. First, a high-level summary of Safer Stimulant clinical program information was completed. Second, medical chart data for all Safer Stimulant Supply program participants in Ottawa was collected and analyzed. Third, participant outcomes related to chart reviews of all current Safer Supply Ottawa participants were compiled.

This report seeks to provide an overview of the 3 Safer Supply programs in Ottawa as well as the results of a program evaluation undertaken in the summer of 2022. As part of this evaluation, two projects were completed. First, medical chart data for all current Safer Supply Ottawa participants was collected and analyzed. Second, a qualitative study including interviews and surveys was undertaken to speak directly with Safer Supply participants about their experiences within the program.

Year: 2024

Journal: Journal of Drug Issues

Abstract:

Canada continues to be in the midst of an ongoing unregulated drug poisoning crisis, with over 40,000 opioid-related deaths since 2016. To develop a better understanding of the context of drug use, we interviewed safer supply program participants in Ottawa, Canada. Data collection included semi-structured interviews which were analyzed thematically. Overall, 2 major themes arose, which included 1) the historical and ongoing effects of trauma, and 2) a cycle of drug use that overwhelmed them. From this, a framework was created which depicts the context of substance use. Our research reinforced the importance of considering the historical and ongoing effects of trauma on the lives of people who use drugs when developing harm reduction and substance use programs. Further, participants found safer supply programs to be useful in disrupting a cycle of drug use they felt trapped in and allowed them a sense of autonomy regarding their drug use.

Year: 2023

Journal: Journal of Substance Use

Abstract:

Background: Harms related to the drug poisoning crisis in Canada continue to worsen, with 20 people dying each day from opioid toxicity related to the illicit drug supply. Safer Supply pilot programs have been implemented in a number of communities as a response to this crisis. This study provides an overview of the planning and implementation of Safer Supply programs in Ottawa, Canada.

Methods: A comparative case study was undertaken to provide a detailed description of the three models of Safer Supply programs in Ottawa, Canada. Portions of the Exploration, Preparation, Implementation, Sustainment framework were used to outline the outer and inner context as well as innovation factors which led to the implementation of these programs.

Results: Three unique Safer Supply programs were implemented in Ottawa. Factors that supported this included the innovation (Safer Supply) being originally conceptualized by people who use drugs, the inclusion of wrap-around services for clients, and ongoing teamwork among the partner organizations.

Conclusions: While each participating organization operates under separate funding models and discrete domains of care, ultimately, we have demonstrated that Safer Supply can be implemented in many different contexts, providing the foundation for scaling this program in other communities.

Year: 2023

Journal: Harm Reduction Journal

Abstract:

Background: As the overdose crisis in Canada continues to escalate in severity, novel interventions and programs are required. Safer Supply programs offer pharmaceutical-grade medication to people who use drugs to replace and decrease harms related to the toxic illicit drug supply. Given the paucity of research surrounding these programs, we sought to better understand the experience of being part of a Safer Supply program from the perspective of current participants.

Methods: We completed semi-structured interviews and surveys with Safer Supply participants in Ottawa, Canada. Interviews were audio-recorded, transcribed, and analyzed thematically. Descriptive statistics were used to report survey data.

Results: Participants most commonly discussed Safer Supply benefits. This included programs offering a sense of community, connection, hope for the future, and increased autonomy. Participants also described program concerns, such as restrictive protocols, inadequate drugs, and diversion.

Conclusions: Our research demonstrated that participants found Safer Supply to be effective and impactful for their substance use goals. While participants did discuss concerns about the program, overall, we found that this is an important harm reduction-based program for people who use drugs in the midst of the overdose crisis.

Year: 2022

Journal: Therapeutic Advances in Infectious Diseases

Abstract:

Introduction: HIV pre-exposure prophylaxis (PrEP) is an effective intervention for preventing HIV infections yet is largely unknown to and underutilized among people who use drugs.

Methods: To better provide services to this group, we present a prospective, single-group interventional study involving the creation of a partnership between a safer opioid supply program and an HIV PrEP program, both of which were nurse-led.

Results: Overall, HIV PrEP was offered to 42 individuals within the safer opioid supply program, resulting in 55% (n = 23) acceptance. Almost half of the group that accepted PrEP identified as female, and nearly all participants were homeless and did not have a primary care provider. While it was challenging to obtain routine PrEP follow-up labs per guideline recommendations due to poor venous access, most participants were able to successfully stay on PrEP and maintained good medication adherence. There were no PrEP discontinuations due to renal impairment and no participants tested positive for HIV.

Conclusion: This novel integration of programs appeared to be a highly effective way to expand access to HIV prevention among people who use drugs. Given the historical and current mistreatment of people who use drugs within the healthcare system, rapport and trust were essential to the uptake of HIV PrEP services. Further, the importance of infectious disease screening among people who use drugs is underscored, and built-in program flexibility and low barrier access is essential.

This webinar was hosted by the National Safer Supply Community of Practice and discussed the results of the Fall 2023 Ottawa Safer Supply program evaluation with a focus on program restarts.

This webinar was hosted by the National Safer Supply Community of Practice and discussed the results of the Spring 2023 Ottawa Safer Supply program evaluation with a focus on Safer Stimulants.

This webinar was hosted by the National Safer Supply Community of Practice and discussed the results of the Fall 2022 Ottawa Safer Supply program evaluation.