Safe Supply and Non-Fatal Overdose

"In this study involving 47 individuals who were admitted to an unsanctioned compassion club, we found that enrolment in the program was associated with a reduction in any type of non-fatal overdose as well as non-fatal overdose involving naloxone administration. These findings, suggesting that enrollment in DULF's intervention likely decreased overdose rates, appear to be amongst the first in a growing body of research on the impacts of a safer drug supply that does not employ the medical system.

"Our findings are aligned with previous evaluations of safer supply programs that have found positive outcomes associated with program engagement, as well as the findings of the scoping review of safer supply programs published in this issue (Ledlie et al. 2024). A previous quantitative study investigating a medicalized and prescriber-based model of safer supply found that enrolment in such programming reduced use of emergency departments, hospital admissions and healthcare costs (Gomes et al., 2022). In addition, several qualitative investigations of safer supply programs, involving prescriber- and vending machine-based programs, have found that such programs help reduce illicit drug use, overdose risk, and led to other improvements in health, social and financial well-being (Bardwell, Ivsins, Mansoor, Nolan, & Kerr, 2023; Ivsins, Boyd, Beletsky, & McNeil, 2020; Ivsins, Boyd, Mayer, et al., 2020; Ivsins et al., 2021; Ledlie et al. 2024; Schmidt et al., 2023). Perhaps most relevant to the current study, a recent quantitative study of a prescriber-based opioid safer supply program in Toronto reported an 80% reduction in non-fatal overdose among participants after 8 months of program engagement (Nefah et al, 2023). However, such programs are known to often suffer from low enrolment and retention rates, attributed in part to inability of such programs to accommodate a large number of individuals and a lack of desirable options and dose for people who use drugs (May, Holloway, Buhociu, & Hills, 2020). This problem may be further compounded by the medical system's inability to prescribe or allow access to illegal drugs (Tyndall, 2020). This in turn has prompted calls for the implementation of more community-based compassion club models operating outside of the medical system as a means of increasing access to safer supply (Thomson et al., 2019). Indeed, some physician leaders have expressed that they would rather not to be responsible for ensuring access to safer supply given the associated ethical issues and the current state of the overburdened healthcare system (Bach, 2022). Our study contributes to the existing literature by describing the impact of a non-medicalized safer supply program on non-fatal overdose.

"People who use drugs, and other experts in the field, have long expressed a demand for a stable, predictable, and easy to access supply of drugs to prevent overdose in the context of the current overdose crisis (Bonn et al., 2020; Health Canada, 2023a; BC Coroners Service, 2023a; Tyndall, 2020). Despite its limited scope, this study has implications for research and policy development specific to safer supply and overdose prevention. The lack of active studies in the field of de-medicalized safer supply distribution highlights the need for more research. Given the recent arrest of DULF's co-founders (Greer, 2023), pathways for exemptions to Canada's Controlled Drugs and Substances Act are needed to enable institutions to run programs and track relevant statistics that can assist policymakers in making decisions (Bonn et al., 2021), as well as revisions to existing policy frameworks, specifically the Special Access Program, the Controlled Drugs and Substances Act, and Food and Drugs Act, which limit the implementation of compassion clubs as a response to Canada's public health crisis (Bonn et al., 2021). This policy hurdle is further compounded by a lack of available licit substances for such a program; there are currently no appropriate approved drugs in Canada's Drug Product Database (Health Canada, 2023b). This further underscores the need for policy changes that facilitate a deeper understanding of the effectiveness of compassion clubs as a means of optimizing support for individuals who are at risk of overdose. Further, additional prospective study of effectiveness is needed, alongside qualitative studies focused on implementation issues and cost-effectiveness research to further uncover the impacts and limitations of this unique approach to safe supply programming."