|
|
Contents
Introduction : À qui s’adresse ce document et à quoi sert-il?
- Section 1.1: What is safer supply?
- Section 1.2: Who supports safer supply?
- Section 1.3: Why not just use methadone or other conventional opioid replacement therapies?
- Section 1.4: Why is safer supply a useful approach?
- Section 1.5: What evidence supports safer supply?
- Section 1.6: What about diversion?
- Section 1.7: Resources to support health care providers
Section 2: Self-Advocacy Tools and Resources for People Who Use Drugs
- Section 2.1: Self-Advocacy Essentials
- Section 2.2: Tools for Self-Advocacy
- Section 2.3: Information and Resources on Safer Supply
- Section 2.4: Harm Reduction and Overdose Prevention Services and Tips
- Section 2.5: Advocating for Peer-Led and Non-Medical Models of Safer Supply
- Section 3.1: British Columbia
- Section 3.2: Yukon, Northwest Territories, Nunavut
- Section 3.3: Alberta
- Section 3.4: Saskatchewan
- Section 3.5: Manitoba
- Section 3.6: Ontario
- Section 3.7: Quebec
- Section 3.8: Nova Scotia
- Section 3.9: New Brunswick
- Section 3.10: Prince Edward Island
- Section 3.11: Newfoundland and Labrador
Introduction : À qui s’adresse ce document et à quoi sert-il?
Vous…
- Recherchez de l’information sur l’approvisionnement plus sécuritaire ou le traitement par agonistes opioïdes (TAO) pour vous même ou pour votre ou vos prestataire·s de soins?
- Recherchez des ressources qui vous aideront à faire valoir vos intérêts et à amorcer la conversation sur l’approvisionnement plus sécuritaire et le TAO avec votre ou vos prestataire·s de soins?
- Essayez de trouver des services spécifiques d’approvisionnement plus sécuritaire, de TAO et de réduction des méfaits dans votre région?
- Accompagnez un·e proche qui utilise des drogues et avez besoin de ressources et d’information?
Cette trousse s’adresse aux personnes qui utilisent des drogues et à leurs prestataires de soins de santé. Pour commencer, les termes utilisés dans le document sont définis à la page 6. La première section explique l’approvisionnement plus sécuritaire et propose aux prestataires de soins des ressources pour orienter leur offre. La deuxième section contient des ressources et des outils qui aideront les personnes utilisatrices de drogues à faire valoir leurs droits, surtout dans les milieux médicalisés. Finalement, la troisième section propose un répertoire régional non exhaustif des services d’approvisionnement plus sécuritaire, de TAO et de réduction des méfaits à l’intention des personnes qui utilisent des drogues.
Cette trousse a été créée par le groupe de travail collaboratif Personnes qui utilisent des drogues – Mouvement pour un approvisionnement plus sécuritaire qui fait partie de la Communauté de pratique nationale sur l’approvisionnement plus sécuritaire (CdPN-APS). Elle est inspirée du Safer Opioid Supply Advocacy Tool Kit créé par le personnel et autres acteurs de Street Health et du Parkdale Queen West CHC de Toronto, au Canada. Le groupe Mouvement pour un approvisionnement plus sécuritaire vise à élargir l’accès aux substances sécuritaires à toutes les personnes au pays qui utilisent des drogues. Il veille également à ce que ces personnes soient correctement incluses dans les programmes, les pratiques et les directives.
Dédicace
Nous dédions cette trousse à toutes les personnes que nous aimons et que nous avons perdues à cause d’une intoxication aux drogues, et à toutes celles et tous ceux qui s’activent sans relâche à maintenir leurs communautés en vie.
Nous savons que les politiques actuelles sur les drogues tuent des gens. Les politiques ancrées dans le colonialisme, le racisme et l’oppression font du tort à nos ami·e·s, à nos proches et aux membres de nos communautés. Elles les surveillent, les contrôlent et approuvent leur massacre social dans toute l’île de la Tortue et partout dans le monde.
Nous constatons avec douleur les impacts de la lenteur et de la lourdeur de la réponse à la crise urgente et persistante d’intoxication aux drogues : les vies perdues à cause d’une surdose évitable attribuable aux drogues toxiques; l’absence de drogues réglementées et sécuritaires; le manque d’espaces sécuritaires et accessibles où utiliser des drogues et pratiquer la réduction des méfaits; l’accès inéquitable aux services de santé, au logement et aux services sociaux; et tous les torts causés par la criminalisation, qui sont tout simplement trop nombreux pour être énumérés.
Les personnes qui utilisent des drogues ont le droit de vivre pleinement, de s’épanouir, d’obtenir du soutien et de goûter à la joie et à la dignité. Nous pleurons et honorons la mémoire de ceux et celles que nous avons perdu·e·s. Malgré que cette crise soit parfois réduite à de simples statistiques, nous ne devons pas oublier que chaque personne perdue à cause de la violence de la prohibition et de la criminalisation était une personne à part entière, digne de reconnaissance, d’attention et d’amour. Nous sommes solidaires des communautés, des proches, des groupes de personnes qui utilisent des drogues et des allié·e·s qui luttent sans relâche pour mettre fin à cette crise.
Nous espérons sincèrement que cette trousse sera utile aux personnes des quatre coins du pays qui utilisent des drogues. Nous savons toutefois que ce document n’est qu’une goutte d’eau dans la mer des ressources nécessaires pour faire de l’approvisionnement plus sécuritaire une réalité pour toutes les personnes qui utilisent des drogues. Nous sommes solidaires avec vous et nous nous engageons à travailler ensemble à élaborer un large éventail de modèles d’approvisionnement plus sécuritaire, à réaliser la décriminalisation, à mettre en place une offre de drogues réglementées et à libérer toutes les personnes qui utilisent des drogues.
Cette trousse n’aurait pas été possible sans le dévouement et le travail de tous les membres de notre groupe de travail. Deux de ces membres qui nous sont chers, Randy Roberts et Alexandra de Kiewit, nous manquent cruellement.
Leur travail dans les domaines de la réduction des méfaits, des politiques sur les drogues et de la défense des droits des personnes utilisatrices de drogues était et restera fondamental pour nos luttes à venir. Nous poursuivons notre travail collectif et solidaire en leur honneur et en la mémoire de leur travail, de leur passion et de leur engagement.
L’espace ci-dessous est vide pour que vous puissiez inscrire le nom des personnes dont vous voulez vous souvenir et honorer la mémoire. Ensemble, nous sommes uni·e·s dans la lutte pour un approvisionnement plus sécuritaire et la libération de toutes les personnes qui utilisent des drogues.
| CAPUD | Canadian Association of People Who Use Drugs |
| CATIE | Canadian AIDS Treatment Information Exchange |
| CDPC | Canadian Drug Policy Coalition |
| FTIR | Fourier-Transform Infrared Spectroscopy |
| HAT | Heroin Assisted Treatment or Heroin Assisted Therapy |
| HCV | Hepatitis C Virus |
| HIV | Human Immunodeficiency Viruses |
| HR | Harm Reduction |
| iOAT | Injectable Opiate Agonist Therapy or Injectable Opiate Agonist Treatment |
| NORS | National Overdose Response Service |
| NSS-CoP | National Safer Supply Community of Practice |
| OAT | Opioid Agonist Treatment or Opioid Agonist Therapy |
| OPS | Overdose Prevention Site or Overdose Prevention Service |
| PSMS | Paper-Spray Mass Spectrometry |
| RAAM | Rapid Access Addiction Medicine |
| SCS | Supervised Consumption Site or Supervised Consumption Service |
| SIS | Supervised Injection Site or Supervised Injection Service |
| SOS | Safer Opioid Supply |
| STI | Sexually Transmitted Infection |
Section 1: Advocating for Safer Supply, OAT, and Harm Reduction with Primary Health and Social Care Providers
If you already have an OAT provider (e.g., your methadone or suboxone doctor) or if you have a primary care provider (e.g., family doctor or nurse practitioner), you can talk to them about safer supply. Here are some tools that you can use to advocate for your own healthcare provider to prescribe you with a safer supply of drugs. These tools include answers to common questions asked by potential prescribers, clinical guidance documents, prescriber resources, and emerging evidence on safer supply. You can share these tools with your healthcare or OAT provider. You can also ask a safer supply team member to speak with your provider to advocate for you to receive a safer supply prescription.
Section 1.1: What is safer supply?
Because the illegal drug supply has become so toxic, people who rely on it are at a higher risk of harm and drug poisoning. Safer supply extends long-established harm reduction models. It is a community-level approach in which physicians and nurse practitioners prescribe oral hydromorphone (Dilaudid®) tablets, often in addition to a slow-release oral morphine (Kadian® or M-Eslon®) “backbone,” to replace the toxic supply that people must otherwise rely on.
Safer supply is a harm reduction approach intended for adults who already rely on the toxic illegal drug supply. Safer supply is in alignment with Health Canada’s strategy to address the drug poisoning crisis.
“I am reaching out to you, Ministers of Health, regulators of health professions and organizations representing health care practitioners, to ask you to do all you can to help provide people who use drugs with a full spectrum of options for accessing medication, depending on their individual circumstances, that will help them avoid the increased risks from the toxic drug supply. This includes your support for programs that provide greater access to a safer, pharmaceutical-grade alternative to the toxic street supply.” - Letter from The Honourable Patty Hajdu, Minister of Health, August 24, 2020
“Naloxone access and training, supervised consumption sites and safer supply programs, are saving lives. Without these interventions in harm reduction, the number of overdose deaths would be exponentially worse.” - Statement by The Honourable Carolyn Bennett, Minister of Mental Health and Addictions, December 15, 2021
Section 1.2: Who supports safer supply?
Beyond Health Canada, some of the other organizations that support safer supply include:
|
|
Section 1.3: Why not just use methadone or other conventional opioid replacement therapies?
Methadone and buprenorphine, the usual first-line treatments, work well for many people but not for everyone. A meta-analysis1 reports that mean retention in treatment after 4-6 months was 57.3% for buprenorphine and 65.5% for methadone. For some people,
- Methadone does not sufficiently suppress withdrawal symptoms or pain
- Methadone does not fulfill cravings or desire of euphoria
- Methadone side effects such as constipation, nausea, sleep and appetite changes, restlessness, and itchy skin can be intolerable.
People who use substances procured from the illegal drug supply often face many barriers to success with traditional addictions' medicine models. Such programs are often time-consuming, have rigid rules, and have limited clinic hours. In general, they are not designed with participant input or with participant needs in mind.
Section 1.4: Why is safer supply a useful approach?
Safer supply provides additional options for people for whom methadone and other first-line drug substitution treatments (i.e., OAT) have not been successful. The goal of methadone programs is typically eventual abstinence, while the goal for safer supply recipients is often stability, harm reduction, and increased access to health and social services.
There has been a rapid increase in fatal and non-fatal drug poisoning overdoses related to the toxic illegal drug supply, and this has been exacerbated by the enduring COVID-19 pandemic. Pandemic-related restrictions on communal spaces have led more people to use drugs alone, with no one available to respond if they overdose. Providing a safer supply of pharmaceutical grade drugs reduces risk of drug poisoning, infectious disease transmission, and death.
Section 1.5: What evidence supports safer supply?
We have an obligation to evaluate internal and external sources of evidence and information, to determine whether we have accurate information about options and their effects in the short and long term, and to act on the best information available.
There is a substantial body of evidence on OAT and heroin assisted treatment (HAT) built over the past 30+ years based on programs in Canada, the United Kingdom, and Europe. Safer supply providers draw on this evidence, existing clinical guidance, and best practices for harm reduction.
Evidence-based research on the successes and challenges of safer supply programs is emerging and currently underway. Emerging research from safer supply programs demonstrate positive health outcomes and psychosocial impacts for safer supply recipients.2,3,4,5
- Improvements in health and social well-being
- Increased access to and engagement with health and social services
- Reductions in drug poisoning and overdose risk
- Reductions in emergency department visits and hospitalizations
- Improved relationships with family members, friends, and community
- Reductions in fentanyl use and other street-acquired drug use
- Reductions in contact with law enforcement
- Reductions in illegal activities
For a more in-depth review of the emerging evidence on safer supply, please consult the full NSS-CoP Evidence Brief on Safer Supply.
Section 1.6: What about diversion?
Diversion is the voluntary or involuntary “selling/trading, sharing or giving away of prescription medications to others”.6 The context of drug prohibition, combined with the current medical model of safer supply, has forced undue focus on the potential harms of diversion and ignored the demonstrated benefits. Drug sharing and diversion practices occur for a variety of unique and valid reasons. Breaking down the social and economic context around diversion moves us towards more shared, accurate, and compassionate understandings of diversion practices:
- Compassionate sharing: Sharing doses with partners, friends, and community members who need pain relief and/or withdrawal symptom relief.
- Survival or subsistence sharing: Sharing, exchanging, and/or selling doses to meet needs such as a place to sleep, basic physical necessities (food, water, showers, more adequate medications/ substances etc.), and/or a safe place to store doses.
- Coerced or forced diversion: Sharing, exchanging, and/or selling doses in response to threats of violence, theft, conflict, etc.
- Unintentional or inadvertent diversion: Diverting doses to others accidentally or involuntarily because of loss, violence, theft, lack of safe places to store doses, etc.
Health care provider emphasis on diversion practices can create distrust, damage prescriber-client relationships, and result in disengagement from health care services.7 Health care providers and service providers must move beyond the tensions concerning diversion and its harm-reducing versus harm-producing effects toward forms of health care and promotion that focus on the needs, perspectives, and priorities of people who use drugs.8
For a more in-depth consideration of diversion practices, see the NSS-CoP FAQ on Reframing Diversion for Health Care Providers.
Section 1.7: Resources to support health and social care providers
National Safer Supply Community of Practice
The NSS-CoP, a collaboration between the London InterCommunity Health Centre, the Alliance for Healthier Communities, and the Canadian Association of People who Use Drugs (CAPUD), has formal and informal prescriber mentoring available.
Physicians and nurse practitioners can access the NSS-CoP Prescriber Hotline. A health care provider experienced in prescribing safer supply will be happy to answer your call.
Weekly drop-in meetings on Thursdays at 12pm EDT/EST are open to all NSS-CoP members (clinicians, pharmacists, program staff, people who use[d] drugs, and others). Participants discuss clinical questions, community updates, and relevant news.
A collection of over 700 resources related to safer supply is available on the NSS-CoP online resource library. The NSS-CoP has also developed a document that addresses prescriber questions and concerns. You can access the full document here: In Brief: Safer Supply for Health Care Providers.
Join us! You can join via the NSS-CoP website and submit any questions to info [at] nss-aps.ca (info[at]nss-aps[dot]ca), or use our Contact form.
Clinicial Guidance
- Safer Opioid Supply Programs (SOS): A Harm Reduction Informed Guiding Document for Primary Care Teams - Hales, J., et al., 2020 (updated version coming later in 2022)
This consensus document represents the clinical experience of the authors. It aims to inform the experience and clinical knowledge of clinicians in working with people who use drugs.
- Safer Opioid Supply Program Protocols: Parkdale Queen West Community Health Centre, Toronto, Ontario | Waraksa et al., 2022
This document compiles clinical and operational protocols developed by staff of the PQWCHC SOS Program, and it will continue to change and grow as the SOS Program evolves. Not all workflows are included here. For more information, and for the most recent version of any of the protocols, please be in touch with the PQWCHC Program Manager, Gab Laurence, at glaurence [at] pqwchc.ca (glaurence[at]pqwchc[dot]ca).
- Risk Mitigation in the Context of Dual Public Health Emergencies and Opioid Use Practice Update | British Columbia Centre on Substance Use, 2022
Updated in 2022, these guidance documents were developed to provide clinical guidance around the prescribing of safer supply in the context of the COVID-19 pandemic. Both documents, an FAQ, several recorded webinars, and other resources are available.
- National Guidance Documents | Canadian Research Initiative in Substance Misuse (CRISM), 2019 onward
CRISM produced six national rapid guidance documents addressing urgent needs of people who use substances, service providers, and decision makers in relation to the COVID‑19 pandemic. Additional resources are available for most of the guidance documents. Topics include:
- Supporting people who use substances in shelter settings during the COVID-19 pandemic
- Telemedicine support for addiction services
- Supporting people who use substances in acute care settings during the COVID-19 pandemic
- Medications and other clinical approaches to support physical distancing for people who use substances during the COVID-19 pandemic
- Strategies to reduce SARS-CoV-2 transmission in supportive recovery programs and residential addiction treatment services
- Harm reduction worker safety during the COVID-19 global pandemic
CRISM also has a national injectable opioid agonist treatment guideline. Note the many supplemental resources at the bottom of the webpage.
- Health Canada Toolkit: COVID-19 and Substance Use | Health Canada, 2020
This toolkit was assembled to support the development of safer supply programs. It includes an FAQ about the legislative and regulatory requirements for substance use disorder treatment/safer supply, a list of all relevant exemptions that have been issued under the Controlled Drugs and Substances Act, and details of formulary coverage under drug plans of medications used for treatment and as pharmaceutical grade alternatives to the illegal supply.
- Guide to Using Slow-Release Oral Morphine (Kadian®) in Opioid Agonist Therapy (OAT) | Équipe de soutien clinique et organisationnel en dépendance et itinérance, lnstitut universitaire sur les dépendances (IUD), CIUSSS du Centre-Sud-de-l’Île-de-Montréal, 2021
This Québec recommendation guides the use of slow-release oral morphine in cases where opioid agonist therapies with methadone or buprenorphine have been proven ineffective, unacceptable, or are contraindicated.
You can find more clinical guidance resources in the resource library.
Section 2: Self-Advocacy Tools and Resources for People Who Use Drugs
Section 2.1: Self-Advocacy Essentials
What is Self-Advocacy?
Self advocacy is about gaining the knowledge, learning the skills, and developing
the confidence to communicate what's important to you.9 Self-advocacy means you are able to speak up for yourself, ask for what you need and want, and tell people about your thoughts and feelings. This is important because you know you best and people need to listen to you if you are not happy, or you want something to change.10
Self-advocacy means you know your rights and responsibilities, and you are able to make choices and decisions that affect your life. The goal of self-advocacy is for YOU to decide what you want then develop and carry out a plan to help you get it.
Speaking up for yourself means you will be able to:
- Take responsibility for yourself
- Make sure people are listening to you
- Say what you think and feel
- Speak up for your rights and the things you believe in
- Make choices and decisions that affect your life
- Decide what you want and then plan to get it11
Top Tips for Self-Advocacy
- Shift Your Perspective: Try to view your situation as something you can change and take control of.
- Be Resourceful: Search for information about your rights and supports that exist that can help you get the things you need.
- Connect With Community: Getting involved in your community will help you connect with others who may have had similar experiences.
- Ask For Help: Seek out help and ask someone you feel comfortable with to help you get started. This might be a family member, friend, community support member, professional advocate, and/or online resources.
- Be Prepared: Prepare for important conversations and interactions. Have a clear plan of the issues you want to raise and the best way to get them across.
- Be Clear: People don’t need to know everything about you, just what you need them to know. Make sure you clearly voice your concerns, wants and needs, so people can help you to the best of their ability.
- Ask Questions: Only end conversations with your healthcare provider until you are sure you have understood everything. Ask questions to clarify and avoid miscommunication.
- Learn to Negotiate: Consider what’s essential to you. Can you compromise on what you need or want? Be clear on what can and can't be changed and begin to negotiate if you can’t reach your desired outcome.
- Keep Going: Self-advocacy is an ongoing long term process - don’t give up! Practice self-care and make sure you have what you need to sustain your hard work.
- Build Confidence: Confidence takes time to grow - be kind and patient with yourself and allow it to happen naturally.
Effective Communication
- Show positive body language
- Think before you speak
- Listen actively and engage
- Stick to the point
- Be confident about what you are saying
- Be open to feedback and constructive criticism
- Consider your tone of voice
- Avoid interrupting others
- Avoid confrontational or abusive behaviour
Finding What You Need to Know:
- Ask advocacy organizations and other professionals for the information
- Look online for resources using a search engine
- Contact an advice-giving service
- Ask others (friends, community supports, etc.) who share your experiences
- Ask for help at the local library
Section 2.2: Tools for Self-Advocacy
The following tools and resources are intended to help support you in your self-advocacy process.
The Essential Self-Advocacy Toolkit: In this toolkit, you will find tips and ideas to help you speak up for yourself and start your self-advocacy journey. It was created by a group of people who all have personal experience of struggling to be heard when trying to get the services and information they need. The toolkit focuses on becoming a self advocate within the health and social care world, but the tools and approaches can also help you to speak up, be heard, and be respected in every area of your life. The toolkit has five sections:
- Introduction to Self-Advocacy
- Section One: Knowledge
- Section Two: Skills
- Section Three: Confidence
- Section Four: Tools
“How to Be in the Room” Training Modules - Canadian Association of People Who Use Drugs (CAPUD):
- Drug Policy 101 - A Guidebook Preparing People Who Use(d) Drugs for Engaging in Drug Policy Processes: This guide is for PWUD who want to become involved with policy and decision-making processes.
- How to Be in the Room - Modules for People Who Use Drugs to be Engaged in Effective Drug Policy (Long Version): CAPUD created a set of training modules from a booklet about how to better engage PWUD in effective drug policy. This is the long version.
- How to Be in the Room - Modules for People Who Use Drugs to be Engaged in Effective Drug Policy (Short Version): CAPUD created a set of training modules from a booklet about how to better engage PWUD in effective drug policy. This is the short version.
Templates and Example Documents for Record Keeping
- Templates: Meeting Preparation Sheet, Meeting Notes, Cue Cards, Important Contacts, Contact Journal, To Do List, Weekly Planner (Pages 3 to 9)
- Templates: Contact Record, Contact List, Sample Advocacy Plan, Sample Advocacy Letter (Pages 14 to 21)
- Template Letter: Service Provider Response to Children’s Aid Society Request to Obtain Client Urine Drug Screening Results: This letter is a template for people who are involved with Children’s Aid Society (CAS). If CAS is asking you or your health and/or social service provider for your urine drug screening results, you can give this letter template to your service provider, and they can personalize it to advocate with you and on your behalf.
Section 2.3: Information and Ressources on Safer Supply
National Safer Supply Community of Practice (NSS-CoP)
- Weekly Group Discussions: Join the NSS-CoP as a member for access to our weekly interdisciplinary group discussions on safer supply, happening on Thursdays at 12pm EDT/EST.
- Our Resources: Essential resources, guides, FAQs, and toolkits on safer supply in Canada.
- Searchable Resource Library: Searchable online library of over 700 resources including academic journal articles, grey literature, knowledge translation materials, clinical practice guidelines, and more.
- Archived Webinars and Workshops: Hot topic webinars and workshops on safer supply, decriminalization, harm reduction, wound care, and more.
Canadian Association of People Who Use Drugs (CAPUD)
- Safe Supply Concept Document: This report is a general outline of the “safe supply” concept, of what safe supply is, and the role of safe supply in drug policy. The purpose of this document is to provide clarity to what is meant by the term “safe supply” with a mind to keeping conversations on point when safe supply and drug policy are being discussed.
Canadian Drug Policy Coalition (CDPC)
- Safe Supply and Harm Reduction Information and Resources: This is a list if you are looking for mental health and harm reduction supports in Canada.
Section 2.4: Harm Reduction and Overdose Prevention Services and Tips
Using Alone and Virtual Spotting
If you are using drugs alone, try to make sure that people can find you. When possible, leave your door unlocked or slightly open. Let people know to check on you - tell someone that you are going to use and make a plan for them to check on you. This instructional video from CAPUD walks you through the step-by-step process of virtual spotting - an overdose prevention method done by phone or video call.
- National Overdose Response Service (NORS) - 1-888-688-6677: NORS is a nation-wide virtual overdose prevention hotline operating 24/7. The service is completely confidential and non-judgmental peers are available to provide support. If you are using drugs and cannot do so at a supervised consumption site or with another person, consider calling NORS while using at 1-888-688-6677.
- Brave App: Brave App is a virtual overdose prevention application available for Apple and Android users. Brave App users are connected with someone who can send help while using drugs alone. Users set up an overdose plan that puts them in control, detailing how, when, and who is sent for help. Supporters activate the plan if an overdose is detected.
- Lifeguard Digital Health: Lifeguard App is a virtual overdose prevention application available for Apple and Android users. The cell phone application will automatically contact emergency responders if a person becomes unconscious or unable to function in the event of an overdose.
- Safer Use Peer Support Line - 1-888-233-5633: The Safer Use Peer Support Line is a support and spotting service so that people do not have to use drugs alone. It is free, non-judgemental, and operated by people who use drugs as part of the Krasman Centre. They have been operating in York Region, but are now encouraging anyone in the Greater Toronto and Hamilton Area to use their service. The Safer Use Peer Support Line is available every night from 10pm-3am.
- Grenfell Overdose Prevention Hotline - 1-888-853-8542: Grenfell Overdose Prevention Hotline is a free, peer-developed overdose prevention hotline that operates 24/7. It is operated by Grenfell Ministries.
Drug Checking and Drug Testing
When possible, try to get your drugs checked by a service in your region. Drug checking services are an important component of harm reduction. These services can be used to determine whether drug samples contain the substance an individual wants to use, determine the purity level of a substance, identify toxic contaminants and unexpected substances, and track drug use patterns. Most harm reduction organizations supply drug testing strips free of charge. You can also order drug testing reagent kits and testing strips online in order to test your drugs at home:
- Drug identification kits from DanceSafe and TestKitPlus
- Drug purity test kits from TestKitPlus
- Fentanyl test strips from DanceSafe
Follow the instructions carefully and remember that drug testing does not mean that your drugs are safe. This is because it is possible to get false negatives and you may not know what drugs or how much of a drug is in your sample. Drug testing should be paired with other harm reduction strategies, such as not using alone, staggering drug use with another person, starting low and going slow, and carrying naloxone.
Safer Supply and OAT Harm Reduction Tips
- Tablet medications contain fillers (e.g. coatings and powders) that can cause harm when injected, such as serious infections, abscesses, and damage to the veins, skin, heart, and lungs. These risks can be reduced by using sterile harm reduction supplies, including sterile filters. The following list includes brochures, infographics, videos, and other resources with helpful safer supply harm reduction information.
- Safer Tablet Injection: A resource for anyone who is injecting tablet medications (pills) and would like to do so more safely - BC Centre for Disease Control
- Safer Injection - Vancouver Coastal Health
- Sharp Shooters: Harm Reduction Info for Safer Injection Drug Use - CATIE
- Video Series on Injecting Tablet Medication - Provincial Health Services Authority
- Guidance for Injecting Tablet Medication
- Safer Smoking - Vancouver Coastal Health
- Safer Crack Smoking - CATIE
- Safer Crystal Meth Smoking - CATIE
- Online Street Degree – Advanced Overdose Response - Provincial Health Services Authority
- Safer Tablet Injection: A resource for anyone who is injecting tablet medications (pills) and would like to do so more safely - BC Centre for Disease Control
Section 2.5: Advocating for Peer-Led and Non-Medical Models of Safer Supply
The medical model of prescribed safer supply is only one possible model of safer supply provision. Other models include low barrier peer-led programs that work closely with safer supply prescribers, and compassion clubs grounded in non-medicalized, non-prescribed forms of safer supply provided within communities of people who use drugs. There might be a group like this advocating and organizing in your region, or you can advocate with your community to start one.
Low Barrier and Peer-Led Models
Low barrier peer-led programs work closely with safer supply prescribers. For example, the MySafe Society operates a limited number of dispensing machines that provide hydromorphone (OHM) tablets to participants on a predetermined schedule. All potential participants undergo a complete evaluation of their drug use, health status, and social situation. There are regular follow-ups with a health care provider and an opportunity to connect with support workers at any time.
This offers a model that is scalable, relatively inexpensive, and is designed to open up the safer supply option for many people who would not be able or willing to enroll in a medically supervised program. It also creates opportunities for consistent monitoring, education, and assistance to manage their drug use.
MySafe Society dispensing machines are currently located in four community-based organizations in British Columbia.
Non-Medical Compassion Club Models
Compassion club models provide a non-medicalized safer supply of drugs to people at high risk of dying from the toxic illegal drug supply. Compassion clubs are a cooperative approach. Drugs are legally (or illegally) obtained from a pharmaceutical manufacturer. Upon receiving the substances, members conduct tests to determine the main active ingredients, fillers or cutting agents, and the presence of any unexpected drugs. Substances are then carefully weighed, properly labeled, and securely distributed to club members. The club also conducts scientific evaluation to assess impacts.12
Compassion clubs prefer to purchase pharmaceutical-grade drugs from a properly licensed and regulated producer. However, this method is not possible under Canada’s current regulatory framework. In the absence of legal ways to obtain substances, groups like the Drug User Liberation Front (DULF) and the Vancouver Area Network of People Who Use Drugs (VANDU) search for and obtain substances in the illegal market through community connections and darknet markets, sourcing from vendors in Canada. Purchasing online has the benefit of reducing interactions and potential violence from buying in-person, and due to the nature of these darknet markets, vendors remain anonymous.13
The DULF and VANDU are one example of an episodic compassion club located in the Downtown Eastside of Vancouver. These episodic compassion clubs have historically been run on major anniversaries related to the provincial health emergency. Currently, they are working towards providing a community-based, peer-led, non-medical safer supply that can be accessed daily by club members.
Below are some resources on low barrier peer-led models and non-medical compassion clubs models for safer supply. There might be a group like this advocating and organizing in your region, or you can advocate with your community to start one.
MySafe Society
- MySafe Society Website
- MySafe Project - We Have An Alternative: Brief explainer video of how MySafe projects operate in community-based organizations in Vancouver and Victoria.
British Columbia Centre on Substance Use
- Report on Heroin Compassion Clubs: This report describes a heroin compassion club model that has the immediate potential to reduce the number of toxic drug poisoning deaths and the impacts of organized crime.
DULF and VANDU
- DULF Website
- VANDU Website
- Evaluative Compassion Club: A Strategic Framework for Preventing Overdose Deaths due to the Unpredictable Illicit Drug Supply: A framework outlining how a permanent (daily access) safer supply compassion club model could be operated and evaluated.
- The 5 W’s of Episodic Compassion Clubs: A two-page explainer covering the five W’s (who, what, why, where, when) of episodic compassion clubs.
- Community-Led Compassion Clubs: The Logical Next Step in Harm Reduction: A webinar by DULF co-founder Jeremy Kalicum on community-led compassion clubs.
- Drug Users Liberation Front of BC: A presentation session hosted by Moms Stop the Harm Webinar, featuring DULF co-founder Jeremy Kalicum.
- Problems with Medicalized Safer Supply: A webinar co-hosted by the NSS-CoP and CAPUD, featuring DULF co-founders Jeremy Kalicum and Eris Nyx.
- Crackdown Podcast - Episode 30 - DULF: DULF co-founders Eris Nyx and Jeremy Kalicum tell the story of how the DULF has stepped up to do what the policy makers refuse to do themselves: offer people a safe version of the drugs they already use.
Section 3: Regional Safer Supply Providers, Opioid Agonist Treatment Providers, and Harm Reduction Resources
This directory contains a non-exhaustive list of regional safer supply providers, OAT providers, and harm reduction resources. If you can’t find what you’re looking for here, or if you’re looking for more resources in your community, these national resources might be useful:
- CATIE “Where To?” Directory: This website is for people looking for HIV, hepatitis C, sexual health or harm reduction services in Canada, with additional resources to support their journey to health and wellness.
- Government of Canada Interactive Map - Canada's Response to the Opioid Overdose Crisis: Use this map to find federally funded locations of opioid-related activities taking place in communities across the country.
- Canadian Drug Policy Coalition - Canadian Harm Reduction Map: Use this interactive map to find harm reduction services in your region.
- Dope Policy Find Harm Reduction Services Map: Use this interactive map to find harm reduction services in your region.
- PIVOT Legal - Canada's Supervised Consumption and Overdose Prevention Sites Map: Use this interactive map to find supervised consumption and overdose prevention sites in your region.
Section 3.1: British Columbia (BC)
Please click here to view the directory for BC.
To download a PDF version of this section, please click here.
Section 3.2: Yukon (YT), Northwest Territories (NT), Nunavut (NU)
Please click here to view the directory for YT, NT, and NU.
To download a PDF version of this section, please click here.
Section 3.3: Alberta (AB)
Please click here to view the directory for AB.
To download a PDF version of this section, please click here.
Section 3.4: Saskatchewan (SK)
Please click here to view the directory for SK.
To download a PDF version of this section, please click here.
Section 3.5: Manitoba (MB)
Please click here to view the directory for MB.
To download a PDF version of this section, please click here.
Section 3.6: Ontario (ON)
Please click here to view the directory for ON.
To download a PDF version of this section, please click here.
Section 3.7: Quebec (QC)
Please click here to view the directory for QC.
To download a PDF version of this section, please click here.
Section 3.8: Nova Scotia (NS)
Please click here to view the directory for NS.
To download a PDF version of this section, please click here.
Section 3.9: New Brunswick (NB)
Please click here to view the directory for NB.
To download a PDF version of this section, please click here.
Section 3.10: Prince Edward Island (PEI)
Please click here to view the directory for PEI.
To download a PDF version of this section, please click here.
Section 3.11: Newfoundland and Labrador (NL)
Please click here to view the directory for NL.
To download a PDF version of this section, please click here.
Footnotes
1 Klimas, Jan, et al. “Retention in Opioid Agonist Treatment: A Rapid Review and Meta-Analysis Comparing Observational Studies and Randomized Controlled Trials.” Systematic Reviews 10, no. 1 (August 6, 2021): 216. https://doi.org/10.1186/s13643-021-01764-9. Back to text
2 Kolla, Gillian, et al. “Safer Opioid Supply Program: Preliminary Report.” London, Ontario: London InterCommunity Health Centre, November 22, 2021. https://www.nss-aps.ca/sites/default/files/resources/2022-LIHC_SOS_Prog…. Back to text
3 McMurchy, Dale, and Robert W.H. Palmer. “Assessment of the Implementation of Safer Supply Pilot Projects.” Ottawa, Ontario, 2022. https://www.nss-aps.ca/sites/default/files/resources/2022-03-safer_supp…. Back to text
4 Ivsins, Andrew, et al. “‘It’s Helped Me a Lot, Just Like to Stay Alive’: A Qualitative Analysis of Outcomes of a Novel Hydromorphone Tablet Distribution Program in Vancouver, Canada.” Journal of Urban Health 98, no. 1 (February 1, 2021): 59–69. https://doi.org/10.1007/s11524-020-00489-9. Back to text
5 Selfridge, Marion, et al. “Cool Aid Community Health Centre Report on Risk Mitigation Guidance Prescriptions: Providing ‘Safer Supply’ in CAMICO Sheltering Sites, Outreach and Primary Care Practice.” Victoria, BC: Cool Aid Community Health Centre, 2020. https://coolaid.org/wp-content/uploads/2021/03/CACHC_RMG_March-August20…. Back to text
6 Larance, Briony, et al. “Definitions Related to the Use of Pharmaceutical Opioids: Extramedical Use, Diversion, Non-Adherence and Aberrant Medication-Related Behaviours.” Drug and Alcohol Review 30, no. 3 (2011): 236–45. https://doi.org/10.1111/j.1465-3362.2010.00283.x. Back to text
7 Duke, Karen, and Julie Trebilcock. “‘Keeping a Lid on It’: Exploring ‘Problematisations’ of Prescribed Medication in Prisons in the UK.” International Journal of Drug Policy 100 (February 1, 2022): 103515. https://doi.org/10.1016/j.drugpo.2021.103515. Back to text
8 Sud, Abhimanyu, et al. “Beyond Harm-Producing versus Harm-Reducing: A Qualitative Meta-Synthesis of People Who Use Drugs’ Perspectives of and Experiences with the Extramedical Use and Diversion of Buprenorphine.” Journal of Substance Abuse Treatment 135 (April 1, 2022). https://doi.org/10.1016/j.jsat.2021.108651. Back to text
9 Advocacy Focus. “Introduction to Self Advocacy.” Advocacy Focus, 2022. https://advocacyfocus.org.uk/wp-content/uploads/2022/04/Introduction_to…. Back to text
10 Self Advocate Net. “What is Self Advocacy.” Self Advocate Net, 2022. https://selfadvocatenet.com/what-is-self-advocacy/. Back to text
11 Rethink Mental Illness. “Taking Control: A Guide to Self-Advocacy.” Rethink Mental Illness. Accessed May 20, 2022. https://www.rethinkessexadvocacy.org/media/to0h313r/taking-control-a-gu…. Back to text
12 British Columbia Centre on Substance Use, “Report: Heroin Compassion Clubs,” BCCSU, 2022, https://www.bccsu.ca/wp-content/uploads/2019/02/Report-Heroin-Compassio… Back to text
13 Drug User Liberation Front and Vancouver Area Network of Drug Users, “Evaluation Compassion Club: A Strategic Framework for Preventing Overdose Deaths due to the Unpredictable Illicit Drug Supply,” DULF, 2022, https://www.dulf.ca/_files/ugd/fe034c_d16d82483593406da4d4459d6f7aa63e… Back to text
About this document
This toolkit was developed by the collaborative People Who Use Drugs Working Group - Action for Safer Supply - as part of the National Safer Supply Community of Practice (NSS-CoP). This toolkit was adapted by Safer Opioid Supply Advocacy Tool Kit put together by staff and stakeholders from Street Health and Parkdale Queen West CHC in Toronto, Ontario.
Please visit https://www.nss-aps.ca/ to learn more.
Written by: Action for Safer Supply Working Group, National Safer Supply Community of Practice
Graphic Design by: Ryan White, R.G.D. / Mixtape Branding
Suggested Citation: National Safer Supply Community of Practice. (2022). Safer Supply, Opioid Agonist Treatment, and Harm Reduction: National Advocacy Toolkit. Canada. https://www.nss-aps.ca/advocacy-toolkit
Version: October 2022
License: Creative Commons – Attribution – Noncommercial
Creative Commons: This means you can share, redistribute, remix, and transform the material. (With the understanding that the citations referenced in this material are
previously copyrighted by the original creators.)
Attribution: You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
Note: Production of this document has been made possible through a financial contribution from Health Canada. The views expressed herein do not necessarily represent the views of Health Canada.
