Current Research on Evidence-Based Solutions
As Canada and the rest of the world continue to grapple with a massive public health crisis driven by toxic, unregulated drugs, a growing body of new evidence is reshaping the response. Prescribed alternatives-commonly known as “safer supply”– are an effective, evidence-based strategy to reduce overdose deaths and improve the lives of people who use drugs.
We at Sunshine Labs have been watching the crisis evolve and are responding to the current needs. In 2021, cocaine was present in 47% of overdose deaths in BC and contributed to 43% of all opioid-related deaths in Ontario during the first year of the COVID-19 pandemic. By 2024 68% of opioid overdose deaths also involved a stimulant such as cocaine or methamphetamine.
The Overdose Crisis and the Rise of Safer Supply
Canada’s overdose crisis is fueled by an illicit drug supply that is increasingly potent, unpredictable, and contaminated, particularly with fentanyl and other synthetic opioids 1. This has led to record numbers of overdose deaths and severe health and social consequences for people who use drugs. In response, safer supply programs have been introduced, offering regulated, pharmaceutical-grade medications to those at highest risk 2.
Safer supply is grounded in harm reduction. It involves healthcare providers prescribing alternatives such as hydromorphone, slow-release oral morphine, and, in some cases, diacetylmorphine (pharmaceutical heroin) to eligible clients 1,2. These programs aim to reduce reliance on the toxic street supply and connect people to health and social supports 8.
What Does the Evidence Show?
Improved Health and Social Outcomes:
Multiple studies and evaluations have found that safer supply programs are associated with substantial improvements in health and social well-being. Participants report decreased use of unregulated drugs, improved mental health and sleep, reconnection with family, and greater control over their drug use 3,4.
For example, a study published this year in The Lancet Public Health found that both safer supply and methadone programs significantly reduced opioid overdoses, healthcare utilization, and costs among people at high risk of overdose 5. Another Ontario-based study reported that those in safer supply programs had lower rates of emergency department visits, hospitalizations for infections, and overall healthcare costs 4.
Reduced Overdose and Mortality Risk:
Preliminary analysis from the Toronto Safer Opioid Supply (SOS) Program revealed an approximately 80% reduction in overdose incidence after program enrollment. Population-level studies in Ontario and BC have also shown reduced opioid overdose-related deaths among safer supply participants.
Decreased Criminal Activity and Increased Stability:
Clients in safer supply programs report reduced engagement in criminalized activities and improved housing and social stability. These benefits extend beyond health, supporting reintegration and recovery.
Complementing Traditional Treatments:
Safer supply is not a replacement for opioid agonist treatment (OAT) or injectable OAT (iOAT), which remain highly effective for many. Instead, it offers a vital option for those who do not tolerate or benefit from existing treatments, or who continue to use unregulated drugs alongside OAT.
Implementation and Ongoing Challenges
While safer supply programs are showing positive outcomes, they face barriers such as limited prescriber capacity, regulatory hurdles, and funding uncertainties6. Successful implementation depends on low-barrier, client-centered models, integration with wraparound services, and strong community and stakeholder buy-in 6.
Concerns about diversion (sharing or selling prescribed medications) have been raised, but current evidence does not show a causal link between safer supply and increased overdose deaths in the community 9. Ongoing monitoring and evaluation are essential to ensure benefits outweigh risks 7.
Conclusion
The evidence is clear: prescribed alternatives to the toxic drug supply can dramatically improve outcomes for people who use drugs. Safer supply programs reduce overdose deaths, decrease use of unregulated substances, and foster engagement in health and social supports. As the crisis evolves, expanding access to evidence-based, regulated alternatives will be critical to saving lives and supporting recovery in Canada and around the world.