"Safer supply is the thing that changes everything": the role of prescribed safer supply in rebuilding trust following experiences of medical abandonment.

BACKGROUND

Prescribed safer supply provides people dependent on street-acquired opioids with pharmaceutical opioids to reduce overdose risk. Previous experience with the healthcare system - including opioid agonist treatment or high-dose opioids prescribed for pain - is common among people dependent on unregulated opioids, as are experiences of significant stigma when seeking care. Our objective was to examine previous healthcare experiences and how these differ from receiving care in safer supply programs.

METHODS

Using reflexive thematic methods, qualitative interviews and focus groups were conducted in 2022 with 38 clients and 10 staff members from two prescribed safer supply programs in different parts of Canada: in London, Ontario and Victoria, British Columbia. Thematic analysis was used to examine themes related to experiences with the healthcare system both prior to initiating safer supply, and following engagement in care in a safer supply program.

RESULTS

Prior to safer supply, participants described three trajectories of medical abandonment: abrupt deprescribing of high-dose opioids despite significant medical complexity, punitive and inadequate opioid agonist treatment, and pervasive stigma in healthcare settings. These experiences left participants deeply mistrustful of healthcare providers and forced to source opioids from the unregulated drug supply. Safer supply programs facilitated re-engagement in care through environments of trust and respect, with provision of opioids as a crucial step toward addressing complex health conditions and achieving social stabilization.

DISCUSSION: Safer supply programs meet a critical need for comprehensive substance use care, reducing overdose risk while supporting management of complex medical conditions and social stabilization. For people previously deprescribed from opioid medications, prescribed safer supply assists in repairing trust and facilitating broader healthcare engagement. Our results caution against punitive, surveillance-oriented practices within safer supply prescribing, as these risk replicating the medical abandonment that created the need for alternative care models in the first place.