Steppingstones Through A Raging Fire: Safe Supply for People who are Unhoused in Vancouver

In British Columbia 2,272 people died from overdose in 2022 due to escalating and unpredictable concentrations of benzodiazepines, fentanyl, and even stronger opioid analogues in the illicit drug supply (BC Coroners Service, 2022a). People who are unhoused are structurally vulnerable to overdose and dying at disproportionate rates. Safe supply is a policy intervention that seeks to replace the illicit drug supply with regulated alternatives to prevent injury or death. Through 6 qualitative interviews and a multi-criteria policy analysis, four models of delivering safe supply were assessed against the following 10 criteria: 1) provision of adequate dosages, 2) range of drug options and formulations, 3) hours in a day drugs can be obtained, 4) number and geographic distribution of access sites, 5) up-front cost for people who use drugs, 6) amount of personal data collected, 7) potential to drive population-level increases in opioid use, 8) burden of implementation, 9) cost to government, and 10) acceptability among key stakeholders. The policy options examined are: a prescribed safer supply model; a non-prescribed model delivered through supervised consumption sites; compassion clubs; and dispensaries. Each model was identified to have particular strengths, but none alone were found to provide sufficient coverage for the diverse needs of unhoused people who use drugs. Based on this analysis, it is recommended that a multiplicity of medical and non-medical safe supply options be adopted. Considerations for implementation including micro and meso logistical factors and the macro legal barrier of the Controlled Drugs and Substances Act are explored.