Participants in a safer supply pilot program in downtown Peterborough will continue receiving prescription opioids “for as long as they need” them, according to the program’s manager.
Current federal funding for the two-year pilot program, operating out of Peterborough’s 360 Degree Nurse Practitioner-Led Clinic, was only supposed to last until June.
But Carolyn King, the program’s manager, said those already enrolled in the safer supply program will be able to keep coming to the clinic for their prescriptions, along with health and social services, even if federal funding isn’t renewed this year.
“We have a sustainability plan in place,” King said. “Our 22 participants will still have access to support and their prescriptions as long as they need it.”
The clinic received more than $1 million from Health Canada over the last two years to develop and run the program. But they had to pause new intakes before reaching their goal of 50 participants last year, because it was uncertain if federal funding would be renewed in 2023, King said.
It was crucial to only take on as many participants as the clinic could continue providing services for over the long term, King said.
“It’s unethical and unsafe to provide a life-sustaining or life-saving service and then cut it off suddenly,” she said. “That creates incredibly high risk for people.”
King and her team are now waiting to hear whether they will receive additional funding from Health Canada this year to expand the safer supply program to 50 participants, up from the current 22.
Meanwhile, the program is showing positive results, said Nancy Henderson, who is leading an evaluation of the pilot.
Not only have participants stopped having overdoses from street drugs, they’re also seeing other improvements in their daily lives, Henderson said.
“People are reporting that they’re feeling healthier. One person is working now, someone else’s relationships with family are improving,” they said.
Currents spoke with Henderson and King recently about how the safe supply program works – and the positive benefits they’re seeing from it. King started by explaining what happens when someone first joins the program:
KING: They meet with our prescriber and the rest of the team and get their prescriptions started. Then it’s a few weeks of working on stabilizing doses, figuring out what health needs are there, what social needs are there, building trust with the staffing team and with each other.
CURRENTS: What do you mean by stabilizing doses?
KING: People come into the program with potentially vastly different patterns around their substance use: how much they’re using, how often they’re using, what their other, potentially-complicating health conditions might be. So a prescriber, like with any medication, has to start with a low dose and titrate up to what is appropriate for the person. Once a stable or effective dose is reached, that frees them up to start working on things like social goals or primary health care needs.
CURRENTS: A key plank of the program is working with people to achieve goals they set for themselves. But they don’t have to be aiming for abstinence. Why is that important?
HENDERSON: Abstinence doesn’t work for everybody. There is a place for abstinence-based programming. We aren’t taking away from what opioid agonist therapy with methadone or suboxone are doing. This is just another tool to have in the community, for people who may not want an abstinence-based approach. People’s goals can be whatever they want. It can be things like wanting to get back to work, wanting to get their licence, wanting to go back to school. Some people then do choose abstinence, but it doesn’t have to be where they end up.
When you ask people, some really do want abstinence. But it might not be what they can do today. So this is kind of a stepping stone way of getting to people’s goals.
CURRENTS: Can you talk more about the goals people are working on?
KING: It can be even just stabilizing their substance use. Some people come into the program not even sure what their goals might be, except for minimizing risk of death through overdose or drug poisoning. Then once they’re freed up from the daily grind of having to source street-sourced substances, their minds become a bit free to start thinking about what they do want their lives to look like. We hear all kinds of things from participants, everything from financial goals, to health care goals, to relationship goals, housing goals, returning to work, returning to school. People are free to express themselves in their unique humanity when given the opportunity, time, energy and brain space to do so – because being dependent on street-sourced drugs is a full-time job. It’s very high risk and takes all of people’s energy and time.
CURRENTS: Nancy, you’re in charge of evaluating the program. Overall, how would you sum up how it’s going?
HENDERSON: It’s still really early in evaluation. But when they first started, we did surveys with people, and then we do them again every four months. People reported that before the program they were having drug poisonings or overdoses, and that’s something that has stopped happening now that they have access to a safer supply. But that is just one measure of success. People’s health is also improving (physical health, mental health), they’re coming to access health care, something they didn’t do before for a lot of people.
People are reporting that they’re feeling healthier. One person is working now, someone else’s relationships with family are improving. There’s less reliance on the street supply that is so toxic.
Something that was really evident is the gratitude that participants have for the team they’re working with, because of how the team makes them feel and how that trust has been developed. The experience is something they’ve never had before. It’s a change in how they’ve been treated. That is helping them follow through on things they couldn’t before.
“Nobody wants to go someplace where they’re treated like less than human“
CURRENTS: You mentioned that a lot of participants were not getting the health care they needed before. Why not?
KING: The number one barrier would be stigma within the health-care system. Historically people who use drugs have not been treated kindly or respectfully by institutions and health-care providers. So there’s huge hesitancy to engage with new health care providers or seek emergency care for very understandable reasons. Nobody wants to go someplace where they’re treated like less than human. We have the time to spend with people to develop trusting relationships and access appropriate referrals to places so they are met with respect when they get there. Or if they’re missing appointments, they have somebody that can speak with them and advocate with them to try to reschedule.
They’re also supported mentally, emotionally, spiritually by program staff. And we can make phone calls, right? It’s pretty hard to follow through on a medical appointment that’s booked three weeks from now if I’m experiencing homelessness, I have no phone, or my phone number changes periodically. We can help bridge those gaps. And it’s really working.
We work with partner pharmacies that we vetted beforehand. We have partner workers at PRHC and work with specific dental clinics that we know are going to treat participants with respect.
“Safer supply… is what’s giving us hope”
CURRENTS: Do you come across people in the community who are skeptical about safe supply?
KING: I think the Consumption and Treatment Services site bore most of the brunt of whatever push back against harm reduction in the community was going to happen. When the CTS opened, safer supply kind of just had a quiet little launch alongside. So I’ve actually been met in the community with honest questions about how it works. Most people I run into understand that safer supply is about saving lives at its core, and that people who are not alive cannot access treatment in the future.
Even if abstinence or treatment is the hill you’re gonna die on as the one and only approach for substance use, you can’t get there without harm reduction first. People seem to have a good understanding of that. I’m really appreciative for the team at the CTS who really fielded most of the community hostility towards harm reduction.
CURRENTS: I get the sense that some people, including some city councillors, feel like there’s too much focus on harm reduction and not enough on treatment.
KING: I think there’s sort of a misunderstanding, if you’re talking about that level of conversation with council, that harm reduction and treatment is an either/or situation. It’s actually both/and. We agree, we do need detox and more treatment. We also need more robust harm reduction things. Those two things aren’t mutually exclusive. It’s actually a spectrum of services that need to be available to meet people where they’re at at any given point in time.
CURRENTS: Doing harm reduction work, you both see the devastation being wrought by drug poisonings. Is this project giving you hope that we can get the drug poisoning crisis under control?
KING: We wouldn’t be here if we didn’t choose to believe that there’s a better future for people who use drugs and for healthcare in general. I’m here because I have hope.
HENDERSON: I’m also doing a PhD right now in nursing. My big push to do that is that we need other models of safer supply – things like buyers clubs and compassion clubs – and we need this to be expanded. We also need research on safer supply and that’s what I’m pursuing in my PhD. I do have hope, and I think that safer supply, not necessarily exactly how it is right now, but safer supply as a concept is what is giving us hope and what’s driving us to keep doing this work every day.
This interview was edited for clarity and length.
CORRECTION: An earlier version of this article stated that the 360 Nurse Practitioner-Led Clinic temporarily capped participation in its safer supply program to make federal funding for the service last longer. In fact, the clinic temporarily paused new intakes into the program because it was uncertain if its federal funding would be renewed and staff wanted to make sure they only admitted as many participants as they could continue providing services to over the long term.
