Evidence map›Paper›PMID 40993664›Full record

ArticleHarm reduction journal2025

'I won't make it without this program': the impact of safer opioid supply program closures in Ontario.

Farihah Ali, Abigale Sprakes, Jordan Mende-Gibson, Cayley Russell, Andrew Shaw, Matthew Bonn, Andrzej Celinski, Nat Kaminski, Mohammad Karamouzian, Carol Strike and 1 more

Abstract read
In one paragraph

Article in Harm reduction journal, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Farihah AliInstitute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, M5S 2S1, Canada. farihah.ontcrism@gmail.com.
Abigale SprakesFaculty of Health and Behavioural Sciences, School of Social Work, Lakehead University, 955 Oliver Road, Thunder Bay, ON, P7B 5E1, Canada.
Jordan Mende-GibsonInstitute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, M5S 2S1, Canada.
Cayley RussellInstitute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, M5S 2S1, Canada.
Andrew ShawInstitute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, M5S 2S1, Canada.
Matthew BonnChangeMark Research & Evaluation, Vancouver, BC, Canada.
Andrzej CelinskiWorkers for Ethical Substance Use Policy (WESUP), Vancouver, BC, Canada.
Nat KaminskiMoyo Health & Community Services, 7700 Hurontario St #601, Brampton, ON, L6Y 5B5, Canada.
Mohammad KaramouzianDalla Lana School of Public Health, University of Toronto, 480 University Ave, Suite 300, Toronto, ON, M5G 1V2, Canada.
Carol StrikeDalla Lana School of Public Health, University of Toronto, 480 University Ave, Suite 300, Toronto, ON, M5G 1V2, Canada.
Jürgen RehmInstitute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, M5S 2S1, Canada.

Funding

Canadian Institutes of Health Research (CIHR) REN- 181677
6 · The paper itself

Abstract

backgroundCanada is in the midst of a worsening overdose crisis, driven largely by the unregulated drug supply. In response, safer opioid supply (SOS) programs were implemented to provide pharmaceutical-grade opioids alongside critical services. However, in August 2024, Ontario's provincial government introduced restrictions on harm reduction initiatives, coinciding with the expiration of federal funding, forcing many programs to close. In their place, the government announced the implementation of Homelessness and Addiction Recovery Treatment Hubs, which exclude harm reduction programs, including SOS programs. This study explores the experiences of SOS program clients and the anticipated impacts of these program closures on their lives.

methodsA qualitative study design was used, involving semi-structured interviews with people who use drugs who were enrolled in six SOS programs across Ontario. Participants were recruited through convenience and snowball sampling. Eligible participants were current SOS clients (≥ 6 months), aged 18 or older, and English-speaking. Interviews were conducted virtually and explored participants' experiences with SOS programs, anticipated impacts of program closures, and strategies to mitigate risks. Data were thematically analyzed using NVivo.

resultsParticipants reported that SOS programs reduced their reliance on the unregulated drug supply, decreased their overdose risk, and connected them to wraparound services. The impending closures triggered widespread fear, uncertainty, and anxiety, particularly about returning to the unregulated supply. Participants also expressed concerns over the loss of access to critical health and social services and the potential decline in their quality of life. Many expressed frustration over the lack of meaningful alternatives, difficulties in securing new prescribers, and distress over forced medication tapers.

conclusionThis study highlights participants' concerns that SOS program closures may force them back into an increasingly dangerous unregulated market, ultimately putting their lives at risk, along with reversing the many benefits SOS programs provided, such as connections to essential health and social services. By replacing harm reduction programs with treatment services, the government is not reducing the demand for opioid use; instead, it forces a return to the unregulated drug market, ultimately putting individuals at risk of overdose.

Indexed as

Analgesics, OpioidHarm ReductionOpioid-Related DisordersAdultDrug OverdoseFemaleHumansIll-Housed PersonsMaleMiddle AgedOntarioQualitative ResearchAnalgesics, OpioidHarm reductionOntarioOpioid crisisOverdose riskPolicy changesSafer opioid supply programs

Identifiers

PMID40993664
PMCPMC12459047

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

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.