Ethical justifications for safe supply interventions

The argument in favor of providing people who use drugs with a pure, regulated supply—an intervention often called “safe supply”—is very straightforward. North America is in the midst of a drug overdose crisis, driven largely by a toxic illicit drug supply. The solution practically presents itself, then: we could just give people access to pure, pharmaceutical-grade drugs, so they know what they're getting and can dose accurately. This idea that we need a “safe supply” is essentially harm reductionist: since people will use drugs, we should do what we can to reduce the secondary harms of that use. Although there is some risk inherent in taking drugs like opioids, those risks are massively increased by the toxic supply, and that's a risk we can mitigate. So we should.

Although the argument is clear and simple, it has not proved very successful in North America. The deep divide between advocates of safe supply (who see it as straightforwardly implied by plausible harm reduction commitments) and opponents of any form of harm reduction (who still adhere to a War on Drugs approach) has made it possible to avoid conducting a more nuanced ethical analysis of safe supply interventions. Thus, I want to suggest that we move past the most radical positions on the permissibility of safe supply, and instead evaluate the ethical issues that arise when we consider the concrete tradeoffs that arise with specific proposals. In particular, I will argue that a crucially important question for evaluating the ethics of a candidate safe supply intervention concerns the actual mechanism of supply, which determines how “low barrier” the intervention is.