A proposal to evaluate safer supply pilot programs in Canada

Safer (or 'safe') supply is defined as a legal and regulated supply of drugs with mind/body altering properties that traditionally have been accessible only through the illicit drug market. Safer supply programs have been established in Canada primarily to reduce overdose caused by the unregulated ("street") drug supply, which is saturated with high-potency opioids (e.g., fentanyl) and potentially toxic adulterants (e.g., etizolam). Beginning in 2019, Health Canada has been funding a growing number of safer supply pilot projects (SSPPs). SSPPs provide standard dose pharmaceutical-grade opioid formulations via dispensation to individuals. These programs appear beneficial but have yet to be subject to systematic evaluation. Understanding how they are organized, the makeup of their clients, and their impact on overdose and other drug-related outcomes is critical to developing an effective response to the opioid overdose epidemic. We propose an implementation science approach that will a) assess SSPP organizational structures, delivery models, and the contexts in which they are being implemented; b) identify the makeup of their clients and assess how SSPPs are impacting client health across distinct settings, and c) track how these programs evolve, particularly in light of the impact of disruptions from COVID-19.