Impact of safer supply programs on injection practices: client and provider experiences in Ontario, Canada.

Marilou Gagnon, Katherine Rudzinski, Adrian Guta, Rose A Schmidt, David T Kryszajtys, Gillian Kolla, Carol Strike

June 2023 Harm Reduct J

Synopsis of Social media discussions

The discussions reflect strong consensus and interest, with examples like claims that safer supply decreases fentanyl use and injection frequency, supported by references to scientific studies and policy debates. The tone is informative and advocacy-driven, highlighting the potential societal benefits, which align with the high engagement and perceived impact of the publication.

A
Agreement
 Strong agreement

Most discussions agree with the article's findings, emphasizing that safer supply programs reduce injection frequency, overdose risks, and improve health outcomes.

I
Interest
 High level of interest

Participants show high interest by referencing multiple studies, policy discussions, and emphasizing the importance of harm reduction strategies.

E
Engagement
 High engagement

Comments demonstrate deep engagement, with users citing scientific evidence, policy proposals, and debating the implications of safer supply programs.

I
Impact
 High level of impact

The discussions suggest that the publication influences policy considerations and public perception, emphasizing the potential for significant social and health impacts.

Social Mentions

YouTube

3 Videos

Twitter

88 Posts

Metrics

Video Views

54

Total Likes

126

Extended Reach

269,984

Social Features

91

Timeline: Posts about article

Top Social Media Posts

Posts referencing the article

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This episode highlights harm reduction services by Positive Living Niagara. Talia Storm, Director of StreetWorks Services, discusses supervised consumption, safe supply, and empowering individuals during the toxic drug crisis. Learn about the increasing opioid toxicity deaths in Canada and the critical need for these servic

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27 views

Effect of Safer Supply Programs on Injection Practices

Effect of Safer Supply Programs on Injection Practices

This video explores the impact of safer supply programs on injection practices in Ontario, Canada, highlighting client and provider experiences. The discussion addresses critical issues related to drug use, fentanyl, and overdose prevention in a qualitative research context.

Medicine RTCL TV

October 25, 2023

20 views

Harm Reduction Strategies in Canada’s Toxic Drug Crisis

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This episode spotlights harm reduction services provided by Positive Living Niagara. Director Talia Storm discusses supervised consumption, safer supply, and services that empower individuals during the toxic drug crisis, addressing the recent increase in opioid-related deaths in Canada.

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March 4, 2024

8 views

  • S K
    @vansk24 (Twitter)

    @Cunnington50818 @KrisCudmore1 @elenoresturko https://t.co/ljUoSorQUb
    view full post

    November 13, 2024

  • Leilani Hawaii
    @hawaii_lei81611 (Twitter)

    @VanSophia @CastanetNews Educate yourself: https://t.co/tLalzOkODN
    view full post

    October 27, 2024

  • Socialism With Characteristics
    @MoikMoikMoik (Twitter)

    @artlowe13 @PDiespecker @Adam_Stirling I deal with research not random observations from fools on twitter https://t.co/bsyeX1Vjkj
    view full post

    September 29, 2024

  • thesecondellen
    @thesecondellen (Twitter)

    Get an education Poilievre: https://t.co/jZDqj6HS2K https://t.co/VsqjG9hVvf
    view full post

    August 21, 2024

    1

  • ConnexOntario
    @ConnexOntario (Twitter)

    Of the accidental apparent opioid toxicity deaths so far in 2023 ( HP33-7E-PDF ), 84% involved fentanyl. This article speaks to the impact of safer supply within community: https://t.co/LkFLqdwZF7 https://t.co/28f8KVLeky
    view full post

    August 8, 2024

    1

  • Grunkle Stan (he/him) | Vaxed | Masked | Elbows up
    @worstninjaever (Twitter)

    @ProtectWard2n3 @ctvregina https://t.co/2CLMshIRqV https://t.co/PSjd2JN56s https://t.co/KHSdX4SBfs
    view full post

    August 1, 2024

  • E.O.A.
    @eastofadelaide (Twitter)

    @TeamPortia @TheTorontoSun @rexglacer @markhdaniell https://t.co/W7bCnKQ5rX
    view full post

    July 21, 2024

  • E.O.A.
    @eastofadelaide (Twitter)

    @RecoverLondon https://t.co/W7bCnKQ5rX
    view full post

    April 25, 2024

  • dee gaud
    @gaudall (Twitter)

    @Roisin06490559 @brianlilley https://t.co/IrqeRl7G3V
    view full post

    March 29, 2024

  • ResignTheKing
    @Scott29686378 (Twitter)

    @GDalander @Twolfrecovery @PierrePoilievre @ABDanielleSmith @ZivoAdam @RecoveryAlberta Really?Because there are multiple peer reviewed studies showing benefits. It isn't just being pulled out of thin air by medical experts, the policy is based on medicine. https://t.co/8DwWxPodBV Here is a new benefit for you. Decreased and safer injections. https://t.co/RLP7DhRFaR
    view full post

    March 23, 2024

  • dee gaud
    @gaudall (Twitter)

    @mferreriptbokaw https://t.co/IrqeRl7G3V
    view full post

    March 9, 2024

  • Sindi Addorisio
    @AddorisioSindi (Twitter)

    @CRF6662 https://t.co/ja9zr1fxoo
    view full post

    February 28, 2024

  • Jill Poklemba
    @jillmarette99 (Twitter)

    RT @CylonSaysNo: @ianhanomansing @CherylWight6 Safe supply and supervised injection sites. https://t.co/8JoE3RVCsJ. https://t.co/wOJz6JdM8n
    view full post

    February 28, 2024

    1

  • Cylon Says
    @CylonSaysNo (Twitter)

    @ianhanomansing @CherylWight6 Safe supply and supervised injection sites. https://t.co/8JoE3RVCsJ. https://t.co/wOJz6JdM8n
    view full post

    February 24, 2024

    3

    1

  • E.O.A.
    @eastofadelaide (Twitter)

    @MatthewTaub @MelissaLantsman @YaaraSaks https://t.co/W7bCnKQ5rX
    view full post

    February 1, 2024

  • Terrill Tailfeathers
    @Terrilltf (Twitter)

    @c0dys_BC @NoLore @CorvusUnknown The evidence is all there out on the open in medical journals and in papers written by scholars and medical professionals. People just have to look. Here’s one: https://t.co/jlipknBjPF Safe supply and harm reduction also helps stop the spread of HIV & other blood borne diseases.
    view full post

    January 25, 2024

  • Magic by West
    @MagicByWest (Twitter)

    @SethBarronNYC @RyanMarino Every Canadian city what? https://t.co/z8xBEXMqpp
    view full post

    January 21, 2024

    5

  • Gordo
    @VancouverGordo (Twitter)

    @Bratt_world @JamesBrowning55 Here's what I found... https://t.co/VW1UBod6G8
    view full post

    January 1, 2024

    1


  • @TriSvcsVet (Twitter)

    @MelissaMbarki “Early evidence suggests that clients enrolled in safer supply programs have significantly reduced emergency room visits and hospitalizations, improved health care engagement, fewer overdoses and overdose-related deaths, reduced drug-related harms” https://t.co/2VSJJXLemq.
    view full post

    December 28, 2023

    1

  • Leilani Hawaii
    @hawaii_lei81611 (Twitter)

    @tammyclough2 @WeebPounder @ZerotheSkepic @Traceskipper @RedIron777 @PierrePoilievre @CPC_HQ https://t.co/ZyUHbrfEEp
    view full post

    December 20, 2023

  • Robert Burns
    @b32935282 (Twitter)

    @PierrePoilievre You're wrong again you're using this to attack people with addictions safe supply works it's been proven they use it all over the world stop the bullshit https://t.co/PPZ3EdMOOF.
    view full post

    December 14, 2023

  • Peggy Cooke pedgehog.bsky.social
    @pedgehog (Twitter)

    @KevinVuongMP Source: https://t.co/Tg5CQ3Iz5A.
    view full post

    December 12, 2023

  • Robert Burns
    @B38922160Robert (Twitter)

    @KevinVuongMP https://t.co/mXw67AdhyG.
    view full post

    December 5, 2023

  • Atika עתיקה
    @Atikatika9jJ (Twitter)

    @somerspsych @AndreaWoo Show me a study how giving safe pharmaceuticals to those who live in poverty and mental illnesses increase crime, despair and death. Here are my sources [1] https://t.co/1xNASnfBXb [2] https://t.co/5p8Vzqt8Cz [3] https://t.co/M13jAn2Xjr 1/2
    view full post

    November 30, 2023

    2

  • MSTH-BC
    @msth_bc (Twitter)

    @somerspsych https://t.co/erPJmkc2V6
    view full post

    November 28, 2023

    1

  • annafoat
    @annafoat (Twitter)

    “Early evidence suggests that clients enrolled in safer supply programs have significantly reduced emergency room visits and hospitalizations” Great ROI Susan. Hospitals are expensive. And weren’t you admonishing the ED last week? https://t.co/DXmofjiSFn https://t.co/mzrY8fv5lN
    view full post

    November 10, 2023

  • Lalani Vanderheide
    @vanderheidl69 (Twitter)

    @Active_Specimen @Dave_Eby https://t.co/zvflbwjeFj
    view full post

    October 26, 2023

  • Gary Allan
    @panelguy1 (Twitter)

    @AustP1985 @RyanR42668 @BHUkno @PierrePoilievre https://t.co/RpToPuvssU
    view full post

    October 21, 2023

  • E.O.A.
    @eastofadelaide (Twitter)

    @JesseJamesAing @ZoeDodd @andreasereda @GillianKolla @nationalpost the actual FACTS would say otherwise https://t.co/W7bCnKQ5rX
    view full post

    October 15, 2023

    1

  • E.O.A.
    @eastofadelaide (Twitter)

    @JesseJamesAing @andreasereda @GillianKolla @nationalpost perhaps you could familiarize yourself with the FACTS regarding safe supply? one interestign FACT is that it REDUCES frequency of injection use. not an opinion. not a theory. a FACT https://t.co/W7bCnKQ5rX
    view full post

    October 15, 2023

  • Mör Agonistos
    @humanedrug (Twitter)

    @dwshelf @DeanPreston It needs more coverage, but you can check this out. 4500 patients aren’t enough to lower the overdoses significantly. https://t.co/VO3Pgy7eDe
    view full post

    September 18, 2023

    2

  • E.O.A.
    @eastofadelaide (Twitter)

    @whichSFdistrict @guyfelicella Is this a real question? Really? There is literally a mountain of evidence demonstrating how harm reduction strategies, like safe supply, rescue injection frequency https://t.co/1nNaV8IH6K.
    view full post

    September 9, 2023

  • Carolyn Hudson
    @cmusician (Twitter)

    @ChefRecovery Depends on what data .. https://t.co/zZp9Gj3zMq. https://t.co/7njJoW75ue
    view full post

    September 5, 2023

  • E.O.A.
    @eastofadelaide (Twitter)

    @AMCKunneke @TristinHopper https://t.co/gswRkpCTxj.
    view full post

    September 1, 2023

    1

  • E.O.A.
    @eastofadelaide (Twitter)

    @TristinHopper https://t.co/gswRkpClHL
    view full post

    September 1, 2023

  • Dee
    @Deeenst (Twitter)

    RT @shdwstar: @fumduq Every aspect of drug war is deadly and brings violence to the community. https://t.co/OtIwExv1dh - https://t.co/5VT9R…
    view full post

    August 28, 2023

    1

  • Shabazz
    @theblackestlist (Twitter)

    @JimRossStrategy @Blake_Allen13 Wait safe supply is not what I suggested. But since you brought it up this study found that it is helping. I didn’t even know about this other than for rehab. https://t.co/1lfpbOZZqH.
    view full post

    August 24, 2023

  • E.O.A.
    @eastofadelaide (Twitter)

    There remains ZERO evidence that #safesupply is fueling opioid use in #ldnont #ontario “The first change was a decrease in the amount of fentanyl used and a decrease in injection frequency” https://t.co/W7bCnKQDhv
    view full post

    August 19, 2023

    2

  • John
    @shdwstar (Twitter)

    @fumduq Every aspect of drug war is deadly and brings violence to the community. https://t.co/OtIwExv1dh - https://t.co/5VT9RhIKW7 - https://t.co/HG9EaeUfUJ - Cartels can't be in charge of the drug supply, we must legalize, regulate, and make drugs accessible.
    view full post

    July 29, 2023

    4

    1

  • John
    @shdwstar (Twitter)

    @LIES_SAM @SenAmyKlobuchar @SenTinaSmith @RepCori @RepAngieCraig @BettyMcCollum04 @Ilhan They need data to make things happen. Here's proof that access to regulated drugs reduces risks of harm. Should be self-evident, as regulated drugs have known dosages, information and instructions. However; https://t.co/OtIwExv1dh
    view full post

    July 12, 2023

    2

  • John
    @shdwstar (Twitter)

    @POTUS Drug war will never work. People need the option to buy regulated drugs directly in pharmacies, dispensaries, and bars. https://t.co/OtIwExv1dh - Arresting drug sellers and drug users leads to fatal overdoses. https://t.co/5VT9RhIKW7 - https://t.co/9uGw4aCj9W
    view full post

    July 12, 2023

    2

  • John
    @shdwstar (Twitter)

    @ACLU_Mass @_OnPointNYC People need the option of buying regulated drugs at pharmacies, dispensaries, and bars. Unregulated drugs are always going to be accessible. Regulated drugs are safer alterative. https://t.co/OtIwExv1dh
    view full post

    July 11, 2023

    3

  • John
    @shdwstar (Twitter)

    @dr4liberty @CatoHealth @CatoInstitute Regulate drugs are safer than unregulated drugs. Prohibition forces the use of unregulated drugs. -- https://t.co/OtIwExv1dh
    view full post

    July 11, 2023

    2

  • John
    @shdwstar (Twitter)

    @ONDCP This is how you decrease overdoses and deaths.
    view full post

    July 11, 2023

  • John
    @shdwstar (Twitter)

    @CMerandi @therealroseanne Sidenote: Here's something you can show politicians, so regulated drugs can become a commercial option for everyone at pharmacies. https://t.co/OtIwExv1dh
    view full post

    July 11, 2023

    3

  • Carrie Mae Garber
    @carriemae68 (Twitter)

    RT @GillianKolla: Very happy to have this addition to the evidence base on Safer Supply programs out. Our team examines the impacts of Safe…
    view full post

    July 7, 2023

    45

  • rebeccaannpenn
    @rebeccaannpenn1 (Twitter)

    RT @GillianKolla: Very happy to have this addition to the evidence base on Safer Supply programs out. Our team examines the impacts of Safe…
    view full post

    July 5, 2023

    45

  • ISSDP
    @ISSDrugPolicy (Twitter)

    RT @GillianKolla: Very happy to have this addition to the evidence base on Safer Supply programs out. Our team examines the impacts of Safe…
    view full post

    July 5, 2023

    45

  • A.P.S.A.D
    @APSADConf (Twitter)

    RT @GillianKolla: Very happy to have this addition to the evidence base on Safer Supply programs out. Our team examines the impacts of Safe…
    view full post

    July 4, 2023

    45

  • AustraliaLEAP
    @LEAPAUST (Twitter)

    RT @GillianKolla: Very happy to have this addition to the evidence base on Safer Supply programs out. Our team examines the impacts of Safe…
    view full post

    July 4, 2023

    45

  • Sam Fenn
    @Samadeus (Twitter)

    RT @GillianKolla: Very happy to have this addition to the evidence base on Safer Supply programs out. Our team examines the impacts of Safe…
    view full post

    July 4, 2023

    45

  • RuthFox
    @RuthMaryFox (Twitter)

    RT @GillianKolla: Very happy to have this addition to the evidence base on Safer Supply programs out. Our team examines the impacts of Safe…
    view full post

    July 4, 2023

    45

  • Morgan magnuson
    @Morgancolemag (Twitter)

    RT @GillianKolla: Very happy to have this addition to the evidence base on Safer Supply programs out. Our team examines the impacts of Safe…
    view full post

    July 2, 2023

    45

  • Bernie Pauly (she/her)
    @BerniePauly (Twitter)

    RT @GillianKolla: Very happy to have this addition to the evidence base on Safer Supply programs out. Our team examines the impacts of Safe…
    view full post

    July 1, 2023

    45

  • Dylan de la Rivière
    @DylandelaRivir2 (Twitter)

    RT @GillianKolla: Very happy to have this addition to the evidence base on Safer Supply programs out. Our team examines the impacts of Safe…
    view full post

    July 1, 2023

    45

  • The Mad Nurse
    @WalkerWitch94 (Twitter)

    RT @GillianKolla: Very happy to have this addition to the evidence base on Safer Supply programs out. Our team examines the impacts of Safe…
    view full post

    July 1, 2023

    45

  • Teresa Winstead
    @teresa_winst (Twitter)

    RT @GillianKolla: Very happy to have this addition to the evidence base on Safer Supply programs out. Our team examines the impacts of Safe…
    view full post

    July 1, 2023

    45

  • Leo Beletsky
    @LeoBeletsky (Twitter)

    RT @GillianKolla: Very happy to have this addition to the evidence base on Safer Supply programs out. Our team examines the impacts of Safe…
    view full post

    July 1, 2023

    45

  • Robert Davidson
    @cmdrbob558 (Twitter)

    RT @GillianKolla: Very happy to have this addition to the evidence base on Safer Supply programs out. Our team examines the impacts of Safe…
    view full post

    July 1, 2023

    45

  • Richard Armour
    @richardarmour99 (Twitter)

    RT @GillianKolla: Very happy to have this addition to the evidence base on Safer Supply programs out. Our team examines the impacts of Safe…
    view full post

    July 1, 2023

    45

  • Marliss Taylor
    @MarlissT (Twitter)

    RT @angelaVos7: Fentanyl has contributed to a sharp rise in the toxicity of the unregulated drug supply and fatal overdoses in Canada. http…
    view full post

    July 1, 2023

    1

  • PattyWilson, she/her
    @Patty__Wilson (Twitter)

    RT @GillianKolla: Very happy to have this addition to the evidence base on Safer Supply programs out. Our team examines the impacts of Safe…
    view full post

    June 30, 2023

    45

  • Angela Vos
    @angelaVos7 (Twitter)

    Fentanyl has contributed to a sharp rise in the toxicity of the unregulated drug supply and fatal overdoses in Canada. https://t.co/xE4sBYFC84
    view full post

    June 30, 2023

    1

    1

  • National Safer Supply Community of Practice
    @NSS_CoP (Twitter)

    RT @GillianKolla: Very happy to have this addition to the evidence base on Safer Supply programs out. Our team examines the impacts of Safe…
    view full post

    June 30, 2023

    45

  • Louise Wallace Richmond
    @lwmediability (Twitter)

    RT @GillianKolla: Very happy to have this addition to the evidence base on Safer Supply programs out. Our team examines the impacts of Safe…
    view full post

    June 30, 2023

    45

  • Andrea DiTullio
    @ammditullio (Twitter)

    RT @GillianKolla: Very happy to have this addition to the evidence base on Safer Supply programs out. Our team examines the impacts of Safe…
    view full post

    June 30, 2023

    45

  • jennifer evans
    @nejsnave (Twitter)

    RT @GillianKolla: Very happy to have this addition to the evidence base on Safer Supply programs out. Our team examines the impacts of Safe…
    view full post

    June 30, 2023

    45

  • Zoë Dodd
    @ZoeDodd (Twitter)

    RT @GillianKolla: Very happy to have this addition to the evidence base on Safer Supply programs out. Our team examines the impacts of Safe…
    view full post

    June 30, 2023

    45

  • John Gianni
    @JohnGianni5 (Twitter)

    RT @GillianKolla: Very happy to have this addition to the evidence base on Safer Supply programs out. Our team examines the impacts of Safe…
    view full post

    June 30, 2023

    45

  • Ricky N. Bluthenthal
    @RNBluthenthal (Twitter)

    RT @GillianKolla: Very happy to have this addition to the evidence base on Safer Supply programs out. Our team examines the impacts of Safe…
    view full post

    June 30, 2023

    45

  • SJ
    @mnsj1968 (Twitter)

    RT @GillianKolla: Very happy to have this addition to the evidence base on Safer Supply programs out. Our team examines the impacts of Safe…
    view full post

    June 30, 2023

    45

  • Elaine Hyshka
    @ehyshka (Twitter)

    RT @GillianKolla: Very happy to have this addition to the evidence base on Safer Supply programs out. Our team examines the impacts of Safe…
    view full post

    June 30, 2023

    45

  • Moms for All Paths to Recovery
    @MomsAllPaths (Twitter)

    RT @GillianKolla: Very happy to have this addition to the evidence base on Safer Supply programs out. Our team examines the impacts of Safe…
    view full post

    June 30, 2023

    45

  • Insiteful Vancouver
    @InsiteVan (Twitter)

    RT @GillianKolla: Very happy to have this addition to the evidence base on Safer Supply programs out. Our team examines the impacts of Safe…
    view full post

    June 30, 2023

    45

  • Check Your Tube Station
    @GhanaboyPharmd (Twitter)

    RT @GillianKolla: Very happy to have this addition to the evidence base on Safer Supply programs out. Our team examines the impacts of Safe…
    view full post

    June 30, 2023

    45

  • Jharna Bajaj
    @BajajJharna (Twitter)

    RT @GillianKolla: Very happy to have this addition to the evidence base on Safer Supply programs out. Our team examines the impacts of Safe…
    view full post

    June 30, 2023

    45

  • Audrey
    @ohmygaudreyy (Twitter)

    RT @GillianKolla: Very happy to have this addition to the evidence base on Safer Supply programs out. Our team examines the impacts of Safe…
    view full post

    June 30, 2023

    45

  • Douglas Laird
    @DouglasBioxyzen (Twitter)

    RT @GillianKolla: Very happy to have this addition to the evidence base on Safer Supply programs out. Our team examines the impacts of Safe…
    view full post

    June 30, 2023

    45

  • @Nephets
    @NephetsYollam (Twitter)

    RT @GillianKolla: Very happy to have this addition to the evidence base on Safer Supply programs out. Our team examines the impacts of Safe…
    view full post

    June 30, 2023

    45

  • Andreas Pilarinos (he/him), PhD, MPP
    @a_pilarinos (Twitter)

    RT @GillianKolla: Very happy to have this addition to the evidence base on Safer Supply programs out. Our team examines the impacts of Safe…
    view full post

    June 30, 2023

    45

  • Nadine Wathen
    @NadineWathen (Twitter)

    RT @GillianKolla: Very happy to have this addition to the evidence base on Safer Supply programs out. Our team examines the impacts of Safe…
    view full post

    June 30, 2023

    45

  • Raagini Jawa MD, MPH, FASAM
    @Raaginizzle (Twitter)

    RT @GillianKolla: Very happy to have this addition to the evidence base on Safer Supply programs out. Our team examines the impacts of Safe…
    view full post

    June 30, 2023

    45

  • Eric S
    @Defundgtapolice (Twitter)

    RT @GillianKolla: Very happy to have this addition to the evidence base on Safer Supply programs out. Our team examines the impacts of Safe…
    view full post

    June 30, 2023

    45

  • Ben Perrin
    @profbenperrin (Twitter)

    RT @GillianKolla: Very happy to have this addition to the evidence base on Safer Supply programs out. Our team examines the impacts of Safe…
    view full post

    June 30, 2023

    45

  • Sheila Vakharia PhD MSW
    @MyHarmReduction (Twitter)

    RT @GillianKolla: Very happy to have this addition to the evidence base on Safer Supply programs out. Our team examines the impacts of Safe…
    view full post

    June 30, 2023

    45

  • Josh Richardson
    @schizosemia (Twitter)

    RT @GillianKolla: Very happy to have this addition to the evidence base on Safer Supply programs out. Our team examines the impacts of Safe…
    view full post

    June 30, 2023

    45

  • Gillian Kolla, PhD
    @GillianKolla (Twitter)

    Very happy to have this addition to the evidence base on Safer Supply programs out. Our team examines the impacts of Safer Supply programs on injection practices, finding a decrease in fentanyl injection & injection frequency among Safer Supply clients https://t.co/Ikp4Q4DWKZ
    view full post

    June 30, 2023

    84

    45

  • Claudio Vidal
    @claudiovidalg (Twitter)

    La introducción del fentanilo ha creado un nuevo "entorno de riesgo" y ha cambiado las preferencias de las personas: igualar este suministro es la forma en que los programas de #SafeSupply pueden seguir salvando vidas y mejorando la salud. https://t.co/Op49h4TAGo
    view full post

    June 30, 2023

    2

Abstract Synopsis

  • Safer supply programs in Ontario have led to significant changes in injection practices, including reduced fentanyl use, decreased injection frequency, and a shift to oral consumption of medications.
  • Participants reported switching from fentanyl to hydromorphone tablets or stopping injections altogether, using safer supply medications as an alternative.
  • These programs not only help lower overdose risks but also improve overall health by addressing deeper gaps in disease prevention and harm reduction efforts.