End of substance use and addiction program funding ‘very, very short-sighted’

Kimberly Mitchell says she’s alive and contributing to her community thanks to the safer supply program at Parkdale Queen West Community Health Centre, one of 22 safer supply initiatives that as of March 31 are no longer receiving federal funding.

Mitchell says she fears the termination of the program will have catastrophic impacts. “It’s going to basically force people to say, ‘You know what? I’m going to go right into rehab or I’m just going back to the streets to get the unregulated drug supply and wait to die.’ ”

Ottawa’s Substance Use and Addictions Program (SUAP) provided time-limited federal funding for nearly 100 community-led organizations and nonprofits like the Parkdale Queen West Centre for a range of substance use prevention, harm reduction and treatment initiatives across the country.

The program will continue to fund projects that address substance use, however their 2023 national call for proposals did not say whether funding for safer supply programs would be a part of future federally-supported initiatives.

Studies show that 75 per cent of opioid overdose deaths in 2024 (between January and September) were linked to unregulated fentanyl from the unregulated drug market.

It’s clear that safer supply provides many benefits, says Gillian Kolla, assistant professor at Memorial University in Newfoundland. “We have a very healthy and robust evidence base in the medical and public health literature . . . developed in the last few years.”

Rebecca Penn, program manager of the National Safer Supply Community of Practice, says an added benefit of the SUAP safer supply programs was low-barrier access to primary care and other health and social wraparound services such as case management, referrals to other services and housing and employment supports.

SUAP projects also provided robust evaluation data as the funding terms required assessment of implementation, models and client outcomes.

A Health Canada spokesperson says the SUAP program was intended to provide time-limited funding “to test interventions prior to broader implementation … (and) was not designed to provide long-term or ongoing funding to projects or organizations.”

Penn says the hope was that the approach could be incorporated into the existing continuum of care and that provincial governments would take over funding of the programs. In 2020, the federal minister of health, Patty Hajdu, sent a letter to provincial and territorial governments encouraging them to remove barriers to implementing safer supply, especially during the COVID-19 pandemic.

Without additional funding from the province, Penn says staff are working to connect clients with addictions medicine providers to access other services including opioid agonist therapy.

Kolla says ending the safer supply programs will not only impact people relying on the services but also health-care costs in Ontario. “I think it’s very, very short sighted of the Ontario government not to continue funding for these programs because they had an established evidence base,” says Kolla. “They were reducing health-care costs, including emergency department visits and hospitalizations.”

Penn shares Kolla’s concerns. “We’re going to see a group of folks who are disconnected from care, and this is happening at the same time as the supervised consumption sites are closing as well.”

In addition to losing SUAP funding for its safe supply operations, Parkdale will also be impacted by the recent wave of attempted SCS closures implemented by the government of Ontario.

Parkdale is a community health centre that includes three locations, one of which is one of the nine centres Ontario will be transitioning to a Homelessness and Addiction Recovery Treatment (HART) Hub. The organization will receive up to four times as much money as they did under the previous provincial funding model, the province has said, but they will not be allowed to offer supervised consumption services. The HART Hubs are abstinence-based treatment models and also ban the distribution and collection of needles and other drug paraphernalia, and prohibits any new safer supply initiatives from being launched.

Mitchell says being on safer supply allows her to focus on other aspects of life rather than the hustle of acquiring unregulated drugs. She now sits on a number of committees and works as a research assistant related to safer supply and harm reduction advocacy.

“I have my mom’s respect that I never thought I would ever get back,” says Mitchell.

Two population-level studies published since 2022, one in Ontario and one in B.C., showed reduced rates of opioid overdose-related deaths for those on safer supply.

Kolla co-authored the Ontario-based study that found those in a safer supply program also had significantly reduced rates of emergency department visits, hospitalizations for infectious complications and lower health-care costs.

In 2022, Health Canada funded an independent assessment of the first 10 SUAP safer supply pilot projects funded in 2020. It found that “almost all clients reported significant improvements to their lives” as a result of the safer supply and other health and social support services.

The next overall progress report from Health Canada was expected this winter but it has not been released yet. Penn says she is confident the results will be consistent with previous evaluations and research. “I think what we’ll see is that there have been lots of benefits that clients have accomplished … in this model of care.”

Despite evidence demonstrating the efficacy of these programs at reducing overdose-related death and other positive outcomes, safer supply programs have received criticism over concerns of diversion or the sharing, exchanging or selling of prescribed safer supply drugs with others not in the program.

These concerns have fed into broader backlash across the country against progressive drug policies that include harm reduction approaches. For example, a recent provincial policy change in B.C. now requires people to consume their hydromorphone doses under observation – something advocates say is untenable given that these doses are short-acting alternatives and may be required every few hours.

A 2023 Statistics Canada report highlights, “Despite recent rises in substance-related deaths, the prevalence of substance use disorders did not increase from 2012 to 2022.” In B.C., a 2023 report from the Office of the Provincial Health Officer noted the rate of opioid use disorder in youth under 19 years of age had remained “stable and low” since 2010 and new diagnoses among youth aged 19 to 25 years had decreased since 2017.

Penn says diversion is not a new concept. “We do know diversion happens. We’ve never pretended otherwise, and we have evidence and papers that talk about how it happens, why it happens, but we still don’t have an understanding of the scope.”

Mitchell says it’s not worth cancelling safer supply programs entirely because of some diversion. “[These programs] help all these people, you know, then now you’re still gonna rock their boat.”

Kolla says now is not the time to end services. Rather, a range of evidence-based treatment in addition to harm reduction options like safer supply and supervised consumption sites are needed.

“We’re still in the midst of an absolutely devastating overdose crisis, and it’s really one of those situations where we need all hands on deck and multiple different forms of options for people.”

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Emily Gwun-Shun Lennon is a freelance reporter based in Edmonton and a fellow in the Dalla Lana Fellowship in Journalism and Health Impact at the University of Toronto.

This article was originally published in Healthy Debate.