Reasons for enrolling in safer supply programs: A longitudinal qualitative study on participant goals and related outcomes in the MySafe program.

ABSTRACT

OBJECTIVE: Safer supply programs are a novel response to the ongoing overdose crisis in Canada - providing people at high overdose risk with a safer alternative to the highly toxic unregulated drug supply. The MySafe program provides pharmaceutical-grade opioids to participants via biometric dispensing machines. This study examines program-related goals and related outcomes across time. METHOD: Longitudinal semi-structured interviews were conducted with 29 study participants at baseline and one-year follow-up. Interviews covered program functionality, experiences, outcomes, and reasons for enrollment and engagement. Baseline and follow-up interviews were compared to explore changes over time, including the effectiveness of the MySafe program in supporting individuals' achievement of their stated goals. RESULTS: Most participants reported similar goals at their baseline and follow-up interviews. The most common goal for initiating and staying in the program was to stop or reduce using street-purchased drugs, followed by abstinence, and wanting to stop injecting drugs. A number of participants described goals addressing issues related to structural vulnerability (e.g., improving living situations). At follow-up, some participants reported reducing street-purchased drug use, no participants reported abstinence, and all those wanting to stop injecting drugs reported achieving their goals. CONCLUSION: Our findings highlight a strong desire among study participants to be separated from the unpredictable street-drug supply. Participants reported variable success attaining their stated goals. However, our results demonstrate the need for such programs to better attend to participant goals, especially those impacted by structural vulnerability, that can be supported with wrap-around social and health care supports.