'With this you’re not chained down to something': contrasting experiences of opioid agonist treatment and safer supply program participation among people receiving prescribed safer supply

Abstract

Background

Prescribed safer supply consists of the provision of pharmaceutical alternatives to people who use drugs to reduce reliance on the highly toxic unregulated supply and mitigate risk of overdose. Prescribed safer supply programs (SSP) have recently been scaled-up in some Canadian jurisdictions, including Ontario, showing demonstratable individual and population level benefits. Differences between prior experiences of opioid agonist therapy (OAT) among clients enrolled in the SSP are not well described, including how safer supply programs differ from existing approaches to OAT provision.

Methods

Drawing on qualitative interviews (n=22) with participants of a safer supply program in Kitchener-Waterloo, a mid-sized southwestern Ontario city, we use thematic analysis to examine contrasting experiences of safer supply and OAT among SSP clients.

Results

There were several key differences identified between OAT and safer supply program models on key programmatic elements, particularly the medical management of withdrawal, tolerance, and medication side effects. Additionally, differences in the program model and philosophy of care impacted therapeutic rapport and provided greater autonomy for SSP clients. The greater autonomy for clients within SSP aligned strongly with client goals and helped maximize program retention, which is key to the public health goal of reducing overdose related mortality.

Conclusion

The findings underscore the benefits of – and urgent need for – collaborative decision-making and comprehensive models of care for substance use, including individualized dosing in both OAT and safer supply programs to improve their public health impact. Participants’ experiences provide a window into reorienting to substance use care that offers potential solutions to longstanding challenges within existing OAT models that undermine retention and therapeutic benefit.