ArticleDrug and alcohol dependence2020
Barriers and facilitators to a novel low-barrier hydromorphone distribution program in Vancouver, Canada: a qualitative study.
Article in Drug and alcohol dependence, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 45 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
45 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Safer opioid supply clients' values and preferences: a systematic review and thematic synthesis of qualitative research.BMJ mental health · 2025Pooled it
- Effect of modified income assistance payment schedules on substance use service access: Evidence from an experimental study.The International journal on drug policy · 2024Trial
- Gender differences in the association between housing status and violence among people who report exposure to benzodiazepines.The International journal on drug policy · 2026Article
- Participant perspectives on a safe supply program in Vancouver, Canada: impacts, satisfaction and improvement priorities.Harm reduction journal · 2026Article
- Willingness to use microbicides among females who use unregulated drugs in Vancouver, Canada.AIDS care · 2026Article
- "With this you're not chained down to something": contrasting experiences of opioid agonist treatment and safer supply program participation among people receiving prescribed safer supply.Harm reduction journal · 2026Article
- The association between benzodiazepine proliferation in the unregulated drug supply and experiences of violence: A gender-based analysis.Drug and alcohol dependence · 2026Article
- A sea of need: provider accounts of strategies used to manage admission demands to safer opioid supply programs in Ontario.Harm reduction journal · 2025Article
- Safer Opioid Supply programs: Hydromorphone prescribing in Ontario as a harm reduction intervention to combat the drug poisoning crisis.Canadian journal of public health = Revue canadienne de sante publique · 2025Article
- Opioid medication doses among safer supply clients: Current safer supply doses and previous OAT experience.Drug and alcohol dependence reports · 2025Article
- Barriers and facilitators to safer supply pilot program implementation in Canada: a qualitative assessment of service provider perspectives.Harm reduction journal · 2025Article
- Perceived impacts of North Americas first de-medicalized safer supply program.Substance abuse treatment, prevention, and policy · 2025Article
- Early experiences and impacts of a fentanyl powder safer supply program in Vancouver, Canada: a qualitative study.The American journal of drug and alcohol abuse · 2025Article
- Preferred pharmaceutical-grade opioids to reduce the use of unregulated opioids: A cross-sectional analysis among people who use unregulated opioids in Vancouver, Canada.The International journal on drug policy · 2024Article
- Opioid-specific harm reduction in the emergency department: how staff provide harm reduction and contextual factors that impact their capacity to engage in harm reduction practice.Harm reduction journal · 2024Article
- "If it wasn't for them, I don't think I would be here": experiences of the first year of a safer supply program during the dual public health emergencies of COVID-19 and the drug toxicity crisis.Harm reduction journal · 2024Article
- Implementation of pharmaceutical alternatives to a toxic drug supply in British Columbia: A mixed methods study.Journal of substance use and addiction treatment · 2024Article
- "It gets you high as a kite but not unsick": Characterizations of and responses to a changing local drug supply by people who use drugs in Rhode Island.The International journal on drug policy · 2024Article
- Article
- How an emergency department is organized to provide opioid-specific harm reduction and facilitators and barriers to harm reduction implementation: a systems perspective.Harm reduction journal · 2023Article
Corrections and comments
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Authors and funding
7 authors.
Funding
Abstract
backgroundNorth America is experiencing an overdose crisis driven by illicitly-manufactured fentanyl, related analogues, and fentanyl-adulterated drugs. The concept of 'safe supply' has been suggested as a potential measure to address the overdose crisis by providing a regulated alternative to illicit opioids to people at high risk of fatal overdose. In January 2019, a novel hydromorphone tablet distribution program was implemented within an overdose prevention site in Vancouver, Canada's Downtown Eastside neighbourhood. This study explored barriers and facilitators to engagement with this program.
methodsIn-depth interviews were conducted with 42 participants enrolled in the hydromorphone tablet distribution program, and over 100 h of ethnographic observation were conducted in and around the study site. Thematic analysis of the interviews and ethnographic observation focused on program operation, including barriers and facilitators to program uptake, access, and engagement.
resultsBarriers to program engagement identified include: limited operating hours and dose schedule, co-location within the overdose prevention site (e.g., wait times), and receiving the generic formulation of hydromorphone. Facilitators identified include: having access to a reliable source of opioids, co-location within the overdose prevention site (e.g., low-barrier design), experiences of agency, and program flexibility.
conclusionOur findings demonstrate key implementation and operational considerations of safe supply programs. In particular, lower-barrier design and operational features should be considered to improve uptake and engagement. Safe opioid supply programs are a promising intervention to address North America's ongoing overdose crisis by providing people at high risk of fatal overdose an alternative to the toxic drug supply.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.