Thread by @rs_mcneil

Thread:

How can we address the severe harms caused by an increasingly toxic drug supply?

Our new article examines what happens when you distribute safer, pharmaceutical opioids (#safesupply) to people at-risk of fentanyl-related overdose.

rb.gy/jf6d0b

Before we get started, and I cannot believe this still needs to be said, fentanyl & fentanyl-adulterated drugs are driving overdose deaths in much of North America.

We need approaches responsive to the changing drug supply, and 'safe supply' programs represent a key innovation.

Now, operating out of @PHScss overdose prevention site in Vancouver's Downtown Eastside, this program distributed hydromorphone as an alternative to illicit fentanyl.

People could receive up to 80 mg/day of hydromorphone to be used onsite (16 mg up to 5 times daily, 2 h apart).

To understand program impacts, we conducted ethnographic fieldwork and interviews with people accessing the program. We interviewed 42 people, 21 of whom completed at least 1 follow-up, before COVID interrupted our study.

So what did we find?

First, access to safer, pharmaceutical opioids reduced the need to use illicit opioids in a setting where fentanyl has replaced heroin & other adulterants (e.g., etizolam) frequently appear.

People continued to use illicit opioids, but did so less often. That's harm reduction.

Second, the program led to improvements in health & well-being, including through access to care at the overdose prevention site.

Because people no longer had to hustle to buy drugs, they reported being less stressed and were able to prioritize their health (sleep, eating).

Third, people commonly reported chronic pain, some of whom had been cut-off opioids by physicians.

(On this: check out recent @crackdownpod episode: crackdownpod.com/podcast/episod…)

For them, safer, pharmaceutical opioids were transformative - providing relief while limiting risks.

Finally, consistent access to safer, pharmaceutical opioids meant people no longer had to spend all of their money on drugs.

This improved economic well-being and allow people to better meet basic needs, while also reducing engagement in unsafe & criminalized income generation.

Ultimately, safe supply programs are a critical innovation in harm reduction - something with the potential to reduce exposure to fentanyl and improve health and well-being.

We urgently need to scale them up, and find ways to maximize their impact.