Canada lacks long-term data on safer supply programs, despite funding these programs for years.

Safer supply programs dispense pharmaceutical opioids as a replacement for toxic street drugs.

There is a growing body of research on safer supply’s short-term health effects. But there are no Canadian studies that evaluate program participants’ health impacts beyond 18 months.

The absence of research into long-term data on safer supply means policymakers do not understand how safer supply affects participants’ health, substance use or social outcomes over time.

“Long-term data is important because it helps us understand not just short-term health outcomes like reduced overdoses, but also broader impacts on quality of life, stability and health care use,” said Farihah Ali, scientific lead at the Institute for Mental Health Policy Research at CAMH. The Centre for Addiction and Mental Health is one of Canada’s leading centres for addiction research and clinical care.

Pilot projects

Canada’s first safer supply programs were introduced in Ontario in 2016. Those programs were initially small in scope, intended for a small group of high-risk individuals.

In 2020, the federal government began funding safer supply pilot programs across the country. Provinces are responsible for the delivery and regulation of these programs.

B.C. introduced provincewide programs in 2021. Other provinces, such as Alberta, have restricted safer supply access to a very small number of clinics, and have generally shifted away from harm reduction models in favour of recovery-oriented approaches.

According to the Canadian Public Health Association, an advocacy organization, the original goal for safer supply was to reduce deaths and harms associated with the unregulated toxic drug supply. It was not meant to replace addiction treatment, but to rather act as a bridge to further care.

However, a 2023 report by researchers at McMaster University and Simon Fraser University noted safer supply “does not principally operate toward goals of treatment or recovery.” The report describes safer supply instead as an emergency intervention focused on stabilization and survival.

Evidence gaps

There is a small but growing body of short-term studies on the health effects of Canada’s safer supply programs. Most only track participants’ outcomes for up to 12 months.

Some of those studies suggest safer supply may reduce the immediate harms associated with drug use.

A 2024 study found a 91 per cent reduction in the risk of death among high-risk individuals receiving safer supply in B.C. Critics have raised concerns about the study’s methodology, sample size and confounding variables.

In contrast, a March study suggested B.C.’s safer supply and decriminalization policies may be associated with increased hospitalizations. These findings also sparked controversy, with experts debating how well the data isolate causal impacts.

And a comparative study released in April also showed some positive outcomes from safer supply. It too sparked significant expert debate.

‘Arms-length’

Of all the provinces, B.C. has implemented safer supply most broadly. The province’s health ministry did not directly respond when asked about the long-term goals of its safer supply program, or whether B.C. collects longitudinal data on program participants’ health outcomes.

“Evidence shows [safer supply] helps separate people from the unregulated drug supply, manage their substance use and withdrawal symptoms with regulated medications, and helps connect them to voluntary health and social supports,” a Ministry of Health spokesperson told Canadian Affairs in an email.

The ministry did not provide the evidence it referenced.

At the federal level, Health Canada confirmed that, to date, it has funded just two evaluations of safer supply programs, despite spending more than $100 million on safer supply since April 2023.

The first was a short-term study, funded by the federal government’s Substance Use and Addictions Program program. Conducted over four months, that study assessed 10 safer supply programs in Ontario, B.C., and New Brunswick. It documented initial impacts on participants’ lives and program delivery, primarily through qualitative methods such as interviews and surveys.

The second study is an ongoing, “arms-length evaluation” of 11 safer supply pilot programs funded by the Canadian Institutes of Health Research (CIHR), Canada’s federal health research agency.

When asked about long-term research on safer supply, Health Canada referred Canadian Affairs to a 2022 funding announcement about this multi-year evaluation. While the evaluation is being conducted over several years, it is unclear if it includes long-term tracking of patients’ outcomes.

Barriers and resistance

There are a number of factors that make it challenging to evaluate safer supply programs over long periods.

Ali, of CAMH, says unstable, short-term funding can disrupt long-term research.

“When programs are shut down or scaled back, we lose contact with participants and the ability to track outcomes over time,” she said.

Program participants can also be difficult to track over long periods, she says. Many struggle with housing insecurity, health instability and criminalization.

Frontline staff also face burnout and high turnover, she says, limiting support for such research activities.

Additionally, there are tradeoffs between the anonymity needed to encourage patients to access safer supply programs and the ability to collect detailed data.

“Ethical concerns — like not wanting to burden participants or risk their safety or confidentiality — require us to design studies that are trauma-informed and flexible, which adds complexity to long-term data collection,” Ali said.

Julian Somers, a clinical psychologist and professor at Simon Fraser University, says B.C.’s failure to conduct long-term evaluations of its safer supply programs is not just an oversight, but an act of negligence.

“B.C. has some of the best pharmaceutical data systems in the world,” Somers said, referring to PharmaCare and PharmaNet — databases that capture every prescription drug transaction in the province.

Somers says his team previously used PharmaNet data to examine prescribed opioids’ effects on health and social outcomes. In 2017, he proposed a long-term safer supply evaluation using these tools.

In 2017, he proposed a long-term evaluation of B.C.’s safer supply programs.

The province declined.

According to Ali, “Future research should explore how safer supply impacts people’s long-term health, stability and connection to care.”

“We also need to listen to people’s experiences, how safer supply affects their daily lives, their sense of dignity, and their relationships with care providers through qualitative mechanisms.”

This article was produced through the Breaking Needles Fellowship Program, which provided a grant to Canadian Affairs, a digital media outlet, to fund journalism exploring addiction and crime in Canada. Articles produced through the Fellowship are co-published by Break The Needle and Canadian Affairs.