{"id":23852,"date":"2023-12-13T15:31:52","date_gmt":"2023-12-13T20:31:52","guid":{"rendered":"https:\/\/www.hivlegalnetwork.ca\/site\/?post_type=blog22&p=23852"},"modified":"2023-12-21T15:44:42","modified_gmt":"2023-12-21T20:44:42","slug":"letter-more-than-130-experts-in-substance-use-call-on-federal-government-to-continue-to-support-and-scale-up-safer-supply-programs","status":"publish","type":"blog22","link":"https:\/\/www.hivlegalnetwork.ca\/site\/letter-more-than-130-experts-in-substance-use-call-on-federal-government-to-continue-to-support-and-scale-up-safer-supply-programs\/","title":{"rendered":"Letter – More than 130 experts in substance use call on Federal Government to continue to support and scale-up Safer Supply Programs"},"content":{"rendered":"

December 14th, 2023<\/span><\/p>\n

The Honourable Mark Holland
\n<\/span>Minister of Health
\n<\/span>House of Commons
\n<\/span>Ottawa, ON K1A 0A6<\/span><\/p>\n

The Honourable Ya\u2019ara Saks
\n<\/span>Minister of Addiction and Mental Health
\n<\/span>House of Commons
\n<\/span>Ottawa, ON K1A 0A6<\/span><\/p>\n

Dear Minister Holland and Minister Saks,<\/span><\/p>\n

As researchers and clinicians across Canada, we are writing out of concern regarding the increased politicization surrounding the response to the drug toxicity overdose crisis that is taking the lives of\u00a0 21 Canadians every day. <\/span>We are particularly concerned about the spread of misinformation and the denial of the evidence-base on harm reduction interventions, such as prescribed safer supply programs.<\/span><\/p>\n

The ongoing drug toxicity overdose crisis needs to be recognized as a public health emergency driven by an unregulated and volatile drug supply composed of fentanyl, fentanyl analogues and other contaminants of uncertain dose and composition. Prescribed safer supply programs aim to reduce overdose by providing regulated, pharmaceutical drugs of known potency and consistency to people who use unregulated drugs. These programs have been piloted on a small-scale since 2020 to provide a new option for people at high risk of overdose and for whom traditional treatment options like opioid agonist treatments (OAT) have not worked or provided sufficient benefit.<\/span><\/p>\n

Research demonstrates positive impacts of safer supply programs<\/i><\/b><\/p>\n

Currently, there are 24 prescribed safer supply programs across Canada receiving federal funding for operations. Research and evaluation conducted over the last three years has demonstrated\u00a0 important and significant health and social benefits for clients in prescribed safe supply programs. <\/span>This includes 15 peer-reviewed research studies and five program evaluations, as documented by a recent rapid review by the Ontario Drug Policy Research Network (ODPRN)<\/b> (1). Published research in well-respected medical and public health journals and program evaluations on prescribed safer supply programs have shown positive outcomes for clients including: decreased use of unregulated fentanyl and related overdose risk; reduced frequency of injection; increased uptake of health services and subsequently improved physical and mental health outcomes; improvements to financial and housing stability; and increased stability and agency over drug use patterns (2-16). Additionally, an analysis of provincial health administrative data in Ontario found significant reductions in emergency department visits, hospital admissions, admissions for infectious complications, and health care costs among people in a safer supply program in the year after beginning safer supply (8)<\/span> .\u00a0<\/span><\/p>\n

However, despite the positive findings from this expanding evidence base, <\/span>funding contracts for 21 currently operating safer supply programs are set to end in March 2024<\/b>. This means that thousands of people nationwide will suddenly lose access to life-saving prescribed safer supply medications. Additionally, many individuals will also lose access to their primary care clinician, as well as vital social support from case managers, health navigators, and harm reduction workers currently working in these programs.<\/span><\/p>\n

Given the ongoing overdose crisis driven by the unregulated drug supply, discontinuing safer supply programs is a dangerous decision. It will foreseeably result in the deaths of people currently receiving\u00a0 regulated prescription of pharmaceuticals, forcing them to return to an unregulated fentanyl market that is volatile and deadly. Furthermore, ending these programs will simultaneously affect existing research projects that are documenting the strengths and challenges of this model of care. This will hinder efforts to generate evidence on the health and social services needed to address drug toxicity deaths across the country.<\/span><\/p>\n

Diversion of prescribed safer supply medications continues to be monitored\u00a0<\/i><\/b><\/p>\n

Current criticisms of prescribed safer supply programs largely center around fears that diversion will lead to opioid related deaths or contribute to new opioid use. Recent calls from healthcare providers and politicians to end life-saving safer supply programs have been based on personal anecdotes or opinion, and often reinforce stigmatizing and fear-mongering narratives about people who use drugs. <\/span>In contrast to these narratives, evidence from both BC and Ontario suggests no measurable impacts from diversion of safer supply medications<\/b>. <\/span>BC Coroners Service has been monitoring the drugs involved in overdose deaths, including in youth (17), and has stated that <\/span>there is no indication that prescribed safer supply is contributing to unregulated drug deaths in the province<\/b> (17)<\/span>. In Ontario, rates of fatal overdoses involving hydromorphone have decreased since safer supply programs were initiated (18). Additionally, the BC Centre for Disease Control recently reported that there has been <\/span>no increase in new cases of opioid use disorder in youth since safer supply began (19)<\/b>. And according to a recent report by ODPRN, in Ontario there were 5,401 opioid-related emergency department visits and 752 deaths for youth aged 15 to 24 from 2014 to 2021, with fentanyl as the primary driver of these fatalities (20). This research also notes that there has been a sustained decrease in OAT prescribing to youth, a critical issue that must be addressed.<\/span><\/p>\n

Questions around diversion and initiation of drug use among youth are important to address, and comprehensive research on diversion and monitoring of trends in substance use initiation and use patterns is ongoing. This research will provide crucial evidence on both the extent and impact of these issues; comprehensive research is necessary to inform policy solutions that are based in evidence. <\/span>Ignoring the coroner\u2019s data on actual causes of drug toxicity deaths while using anecdotes as rationale to end programs showing positive results in numerous research studies conducted in multiple provinces would be reckless and harmful.<\/b><\/p>\n

Ending funding for safer supply programs has dangerous consequences<\/i><\/b><\/p>\n

Prescribed safer supply programs are providing accessible, low-barrier care to people for whom other treatment modalities like OAT have not been effective (21-24). <\/span>Existing research has documented how rapid tapers and opioid deprescribing puts peo<\/span>ple at high risk of using opioids from unregulated sources and subsequent overdose (25-29). <\/span>Research and program evaluations have also documented how many <\/span>people receiving care through prescribed safer supply programs have struggled to access primary care through mainstream delivery models, were disconnected from care prior to receiving safer supply, and their needs have not been met by traditional addiction treatment program<\/b>s <\/b>(11). Due to the complexity of their needs, there is a strong danger that people who lose access to safer supply programs will not only lose access to a source of regulated, prescribed opioids, but will also lose access to the comprehensive primary care they have been receiving through SUAP-funded programs. This will result in poor health outcomes and even death for many people currently receiving safer supply.\u00a0<\/span><\/p>\n

The number of preventable fatal poisoning deaths caused by the unregulated fentanyl supply in Canada is staggering and constitutes a major public health emergency. There is a history of contentious and highly politicized debates delaying the implementation and scale-up of life-saving harm reduction programs, despite research evidence showing strongly positive benefits. Examples include syringe distribution programs, supervised consumption sites, heroin-assisted treatment and now, prescribed safer supply programs. The resistance to providing long term funding for prescribed safer supply programs is not justifiable based on the current evidence-base, with over 20 peer-reviewed publications and program evaluations showing the effectiveness of these programs. Research and evaluations should continue to explore potential challenges and issues, such as the scale, magnitude and impacts of any diversion that might be occurring. However there is a danger that the implementation of safer supply programs will be delayed by contentious and highly politicized debates, and that currently operating safer supply programs providing crucial and life-saving care will be forced to close due to lack of funding. This will predictably result in unnecessary deaths as people are forced to return to the unregulated drug supply, and must be avoided based on the current evidence available.\u00a0\u00a0<\/span><\/p>\n

Due to this, we call on the federal and provincial governments to immediately:<\/b><\/b><\/p>\n