Implementation Barriers and Outcomes of a Provincial Prescribed Safer Supply Initiative among Indigenous People who use Substances amid Covid-19 and a Toxic Drug Crisis in British Columbia, Canada

Background: In 2020, British Columbia (BC) introduced Risk Mitigation Guidance to support the provision of prescribed safer supply (PSS) to people at risk of toxic drug harms and death amid the COVID-19 pandemic. We sought to assess the self-reported barriers to and outcomes of PSS among Indigenous people who sought or accessed a prescription. Methods: Cross-sectional and longitudinal surveys with up to 5 time points per participant over 3 months were used to collect data on health, health care, and systemic barriers. Outcome measures included health-related quality of life, psychosocial well-being, and behaviours related to unregulated substance use, COVID-19 protection, and criminalized income generation. Generalized estimating equations were used to assess the effects of time-varying PSS exposure on outcomes over the follow-up period. Results: Among the total sample (n=131), past negative experiences (64%), drug use stigma, (51%), mistrust (49%), negative reactions from health care providers (48%), and lack of privacy (46%) were reported in health care settings. Among the longitudinal cohort (n=102), there was no evidence of an effect of prescription receipt on change in any outcome over time or over the 12-week follow-up period, independent of prescription status, apart from COVID-19 protective behaviours, which showed a small increase over time (adj. β = 0.0090, 95% CI = 0.0043, 0.014). Conclusion: Limitations of the early implementation of PSS in BC included its medicalized delivery and lack of wraparound supports. Further work must be done to ensure the effectiveness, relevancy, and safety of prescribed safer supply for Indigenous people

Cohort · Health care · Indigenous · Longitudinal study · Medical prescription · Psychosocial · Receipt · SAFER · HIV, Drug Use, Sexual Risk · Opioid Use Disorder Treatment · Poisoning and overdose treatments