By Nanky Rai, Gillian Kolla, Andrea Sereda, Jess Hales Emmet O'Reilly and Tom Man

This information is directed to a medical audience, but we at MSTH felt that many of our followers also want to learn more about #SafeSupply because the lives of those we love depend on it. We thank Dr. Nanky Rai and others like her who have decided to change the system, because we can’t wait.

In [square brackets] is text MSTH added for clarification.

Text from a twitter thread by Dr. @NankyRai

This is information about our program development process & guidance document [on safe supply] in the spirit of building greater community accountability and transparency. As clinicians and researchers its important for us to acknowledge that calls for ‘Safe Supply’ come from communities of PWUD [People who use drugs].

Demands have been clear: access to a regulated drug supply & decriminalization to address structural violence facing PWUD.

For #medtwitter [or any of our readers] interested in understanding #SaferSupply, I urge you to read the position statement on Safe Supply by CAPUD (Canadian association of people who use drugs) first: https://vancouver.ca/files/cov/capud-safe-supply-concept-document.pdf

Current Emergency Safer Supply Programs (ESSP) that exist in London & Toronto are HARM REDUCTION PROGRAMS that aim to respond to calls from PWUD re #SafeSupply AND use existing medical evidence to create a hybrid medicalized model focusing on opioids called #SaferSupply.

Medicalizing a community call to action comes with implications & demands more accountability from healthcare workers. Models that exist outside institutions altogether are desperately needed, example: #HeroinBuyersClubs read more on the BCCSU website https://www.bccsu.ca/wp-content/uploads/2019/02/Report-Heroin-Compassion-Clubs.pdf.

The scale of the devastation from #OverdoseCrisis has prompted direct action from PWUD. Right now, prescribers [primary care physicians and others] are uniquely positioned to act re: the poisoned drug supply. It means we [physicians] must embrace discomfort, act thoughtfully and urgently with tools we have access to. #WeActTheyLive

Safer Supply programs do not claim or aim to replicate the paradigms of traditional addiction medicine. Safer Supply programs are lower barrier community-based programs situated in primary care that meet people where they are at. We do not pathologize drug use.

Many PWUDs have had repeated negative experiences within the addiction treatment system. Many PWUDs don’t want to experience stigmatizing health"care". And many PWUDs in this fentanyl and analogues era feel 1st line options/meds (MMT/bup) [Treatment with Methadone or Suboxone] alone are not enough. Therefore ESSP [Emergency Safe Supply] programs are grounded in the belief that people who use drugs are experts. We are invested in treating our clients with dignity and respect and repairing their relationships with the health care system.

Our programs are trying to radically shift how health care protocols, programs & practices are created and evaluated by building direct involvement of PWUDs. Upholding the principles of #NothingAboutUsWithoutUs

We started with focus groups with PWUDs in our communities to better understand what would and what wouldn’t work and/or feel respectful. Other ways we are building greater community accountability? Advisory committees made up of PWUDs for our programs. Based on the feedback we've received and the med literature we have access to, we've developed a guidance document for #SaferSupply. In this we offer clients access to dilaudid 8 mg IR tabs AND SROM to combat the toxicity and potency of the street supply.

And yes we do offer bup(+microdosing)/SROM [Naloxone and Slow Release Oral Morphine, e.g. Kadian]. We also have client health navigators that support people in attending appointments for MMT [Methadone Maintenance Treatment] when desired. But we can’t keep relying on the same tools & hope for different outcomes to get through this evolving unprecedented crisis.

We provide #SaferSupply because we can't wait for healthcare system to catch-up & provide anti-oppressive, non-stigmatizing care for PWUD (ex. methadone mills). Harm done needs to be repaired but we can't wait for that while people in our communities are dying.

We provide #SaferSupply because people have the right to access health care whether they want to stop drug use or not, whether they want to get high or not. People have the right to live and survive through this crisis.

We provide #SaferSupply because building just relationships is what's important. The antidote to violence is connection, not paternalism and oppressive medical institutions and providers.

This is why we are sharing our guiding document here & are open to feedback/criticism, keeping in mind we will be prioritizing feedback we get from directly affected communities. We are committed to centering PWUD in this process https://docs.google.com/document/d/1hXRmNaOTB60wbmNqhBi5P_xxktEZnXFDWKMkJMu5ALM/edit

We are grateful for the support & leadership of our respective institutions that are invested in building responsive programs accountable to the communities we serve. @PQWCHC @SRiverdaleCHC @StreetHealthTO @HealthCentre

We are also engaging in rigorous research of our work.

There has been widespread support for #SaferSupply from organizations including @AllianceON @FCM_online and the federal government who launched the SUAP call for low barrier safer supply programs earlier this year: https://www.canada.ca/en/health-canada/services/publications/healthy-living/substance-use-addictions-program-call-for-proposals-guidelines-applicants.html#a3

We commit to valuing and supporting the lives of PWUD. We call on our colleagues to take brave, urgent action to stop the unnecessary deaths, marginalization & stigmatization of PWUD. Just like communities of PWUDs have always done, we need to Keep Six.