Future of Canada's first-ever 'safer supply' drug program uncertain with funding set to end in spring

A London, Ont., physician says she and others are torn between continuing prescribing drugs to their patients living with addiction, or weaning them off as federal safer supply funding is set to end in March with no word of renewal. 

Ottawa invested $9.5 million in prescribed safer supply programs nationwide in 2020 as part of efforts to combat the opioid crisis. A $6.5-million boost went to London Intercommunity Health Centre, which at that point had been running Canada's first-ever safe supply program for four years. 

The funding went to hiring more nurses, case managers, care facilitators, social workers, outreach workers and housing workers who helped expand the patient roster to 274 current participants. Head physician Dr. Andrea Sereda said she fears those individuals will be put in danger should they suddenly lose access to the care they've come to depend on. 

"They will return almost certainly to the fentanyl-based unregulated street supply, where their risk of death from overdose or infection, or the consequences of criminalization of drug use, will drastically increase," said Sereda. 

Sereda is among 130 experts in substance use who have signed a letter urging the federal government to continue and increase its support as the drug toxicity overdose crisis worsens. In all, funding is expected to end for 21 safer supply programs in the spring. 

"Things are bad," said Sereda. "We're seeing an unregulated street supply that's cut with any manner of different drugs: fentanyl, fentanyl analogs, carfentanil, benzodiazepines, things like xylazine, nitrazine-type compounds as well. The supply has only gone in the direction of being more volatile and more toxic." 

It is what has led to an expansion in the harms related to street-level use, she said. Fentanyl is typically injected every one to two hours, and more injections inevitably means more infections. 

The safe supply program has been one of the few interventions available to save lives, said Sereda. The take-home prescription model used in Ontario has allowed patients to suppress withdrawal from fentanyl and stabilize their lives while staying in regular contact with service providers. 

Prevents overdoses, reduces hospital admissions

Of the 248 safe supply program participants at Sereda's clinic at the time, one-third stopped using intravenous drugs altogether, while overdoses dropped from 59 per cent to 23 per cent in six months, a study published in 2022 showed. 

A survey published in the Canadian Medical Association Journal also shows London patients in the program significantly declined their hospital admissions compared to the year before.  

Despite this and other peer-reviewed studies showing the benefits of safe supply, the future is unclear for Sereda and other physicians heading Canada's programs. Most are applying for renewal, she said, but to her knowledge there have been no updates on how things will move forward. 

As an individual and physician working in safe supply for eight years, she said she wonders whether moral panic could be influencing policies. As Canada's opioid crisis grows, there have been calls for safer-supply programs to stop and for more investments to be made in treatment programs.

"It is not based on any published scientific evidence and it is not based on the expertise of clinicians providing safer supply," Sereda said. 

"It's my worry that we're getting into a place where a health intervention that's been proven to save and improve lives is getting stuck in the political realm, and we're going to make political decisions instead of healthcare decisions based on evidence." 

Health Canada declined requests for an interview from CBC London. In a statement, it said its Substance Use and Addictions Program (SUAP) provides time-limited funding to community-led and not-for-profit organizations in Canada. 

Through the 2023 national call for proposals, it will continue to fund projects that address substance use issues across the continuum of care. 

It would not say whether funding for safe supply programs would continue, but funding is for projects that are anticipated to begin as early as June 1 2023 and must be completed no later than March 31, 2028.