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Findings/Key points
We collected data from December 2020 to January 2023 on clients receiving safer opioid supply from five frontline service providers in Toronto, Canada, using interviewer-administered questionnaires. We assessed the incidence rate ratio of self-reported overdose comparing pre- and post-enrolment in the programs and examined changes in the prevalence of social and substance use outcomes post-enrolment. Forty-one participants were recruited, of whom 26 were followed up for a median of eight months (interquartile range, 5.0–11.7). The incidence rate ratio of overdose comparing post-enrolment to pre-enrolment was 0.20 (95% confidence interval, 0.09–0.43). Participants reported several positive social and substance use outcomes at follow-up, including a reduction in reliance on the unregulated supply and reduced criminal activity.