Exploring models of safer supply provision: A qualitative study on the preferences of people who access the unregulated drug market

Abstract

Background: People who use drugs and other experts have long advocated for a supply of regulated drugs of known quality and composition as an alternative to the toxic and unregulated drug supply that is causing unprecedented rates of death and injury in Canada and internationally. Prescription based safer supply programs often fail to meet the diverse needs of people who access the unregulated market. This study explores a range of possible models to enhance implementation of prescription and non-prescription safer supply based on preferences and goals of people who use drugs.

Methods: We conducted a secondary analysis of three qualitative data sets from studies that explored various practical and theoretical elements of safer supply from the perspectives of people who use drugs. Our analysis included 175 responses from the perspectives of individuals who access the unregulated drug supply, receive prescribed alternatives to the unregulated supply, and/or work in front line harm reduction. We conducted a thematic analysis, using the insights to describe a range of possible safer supply models spanning both prescription and non-prescription models.

Results: Five possible safer supply models were identified: team based prescribed safer supply, buyers' club, compassion club, events space distribution, and dispensary. The range of models reflects participants diverse goals, preferences, and desired outcomes for safer supply.

Conclusion: Our findings emphasize the importance of a range of models implemented concurrently to address a population level crisis. Importantly, models outside of a prescriber-based model were often preferred for their orientation towards community care and the ability to move beyond the inherent limitations of medical models of prescribed safer supply.

Keywords: Buyers club; Compassion club; Harm reduction; Overdose; Safe supply.