Gatekeeping safe supply: A community-engaged qualitative study of the perspectives of people who use drugs and frontline workers on the barriers to access, uptake, and retention of prescribed safe supply

Prescribed safe supply is an intervention intended to address the significant fatalities and harms associated with the unregulated drug poisoning crisis, through access to a regulated drug supply. As an emerging initiative, barriers to uptake and retention of prescribed safe supply are not fully known. This qualitative, community-engaged research investigated the perceptions of people who use drugs and frontline workers in Canada regarding participatory barriers to this intervention using in-depth interviews. Data analysis was guided by the 'risk environment' framework. Study findings document accessibility barriers (including limitations of the medical model, operational and regional issues, impacts of socio-structural disadvantage, regulatory contexts, and identity-specific concerns) and actionable considerations that may enhance intervention uptake and retention. To address these identified barriers, policymakers may consider reframing programs as public health (rather than medical) responses, including emphasizing key ethical standards of responsible public health practice in the provision of safe supply.