“Safer supply” alternatives to toxic unregulated drug markets

In Canada, an average of 22 people died from opioid toxicity each day in the first six months of 2023, with 84% of these deaths involving unregulated fentanyl.1 In response to this crisis of drug related deaths, people who use drugs have advocated for models of “safer supply.” These interventions range from the testing and distribution of drugs by activists to the prescription of pharmaceuticals by clinicians and the legal regulation of drug manufacture and supply.2

In a linked paper (doi:10.1136/bmj-2023-076336), Slaunwhite and colleagues evaluated the effects of a prescribed safer supply intervention in British Columbia that was introduced in response to the dual public health emergencies of toxic drug deaths and covid-19.3 Safer supply became particularly important during the pandemic as border closures worsened the volatility of drug supply and the risks of withdrawal and overdose were exacerbated during isolation and quarantine.4 The provincial government issued “Risk Mitigation Guidance,” which allowed clinicians to prescribe opioids and stimulants to people at risk of overdose, withdrawal, or other drug related harms.5

Safer supply is controversial among some physicians and researchers, who have raised …