Impact of safer supply programs on injection practices: client and provider experiences in Ontario, Canada

• Published in: Harm reduction journal Vol. 20; no. 1; p. 81
• Main Authors: Gagnon, Marilou, Rudzinski, Katherine, Guta, Adrian, Schmidt, Rose A, Kryszajtys, David T, Kolla, Gillian, Strike, Carol
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 28-06-2023; BioMed Central; BMC
• Subjects: Clients; Drug overdose; Drug Overdose - prevention & control; Drug use; Drugs; Emergency medical care; Fentanyl; Harm Reduction; Health Promotion; Health risk assessment; Health risks; HIV; Human immunodeficiency virus; Humans; Injection; Interviews; Management; Ontario; Overdose; Qualitative analysis; Qualitative research; Questionnaires; Safer supply; Sociodemographics; Supply and demand; Toxicity; Ontario; Canada; Ontario Canada; Drugs; Qualitative research; Substance use; Fentanyl; Safer supply; Overdose; Injection
• ISSN: 1477-7517; 1477-7517
• DOI: 10.1186/s12954-023-00817-7

Fentanyl has contributed to a sharp rise in the toxicity of the unregulated drug supply and fatal overdoses in Canada. It has also changed injection practices. Injection frequency has increased as a result and so has equipment sharing and health-related risks. The aim of this analysis was to explore the impact of safer supply programs on injection practices from the perspective of clients and providers in Ontario, Canada.
The data set included qualitative interviews with 52 clients and 21 providers that were conducted between February and October 2021 across four safer supply programs. Interview excerpts discussing injection practices were extracted, screened, coded and then grouped into themes.
We identified three themes, each theme corresponding to a change in injection practices. The first change was a decrease in the amount of fentanyl used and a decrease in injection frequency. The second change involved switching to injecting hydromorphone tablets instead of fentanyl. Finally, the third change was stopping injecting altogether and taking safer supply medications orally.
Safer supply programs can contribute to reducing injection-related health risks in addition to overdose risks. More specifically, they have the potential to address disease prevention and health promotion gaps that stand-alone downstream harm reduction interventions cannot address, by working upstream and providing a safer alternative to fentanyl.