Barriers and facilitators to safer supply pilot program implementation in Canada: a qualitative assessment of service provider perspectives.

Background: In response to the ongoing drug toxicity crisis, driven by fentanyl and its analogues in the unregulated drug supply, Canada has funded several safer supply programs, which provide pharmaceutical-grade medications to reduce the reliance on toxic unregulated drug supply for people who use drugs. In this study, we examined barriers and facilitators that influenced the implementation of integrated safer supply pilot programs (ISSPP) across Canada.

Methods: Between March 2022 and May 2023, we conducted a qualitative study using semi-structured interviews with key informants from ten ISSPP located in three provinces across Canada. Data analysis and interpretation of findings were guided by the Consolidated Framework for Implementation Research (CFIR). Thematic analysis was used to code transcripts and identify themes.

Results: ISSPP varied greatly in the degree of ancillary and wraparound services provided. Additionally, differences existed across the ten programs in terms of eligibility criteria for enrolling clients and the availability of medication options. We found twelve constructs and three sub-constructs across four domains of CFIR that influenced the implementation of ISSPP. Implementation facilitators included low-barrier and client-centered delivery model, ongoing needs assessment through program monitoring and evaluation, integration of wraparound care, partnership with local services to coordinate client care, community buy-in, clinical protocols and standardized practices, and multidisciplinary care teams with motivated staff. Major barriers to ISSPP implementation were a volatile and toxic unregulated drug supply, complicated policy environments, unsustainable funding models, unsupportive regulatory environments, limited medication options, limited physical space, as well as staff shortage.

Conclusions: Despite several internal implementation facilitators, ISSPP faced many external and policy-level implementation barriers. Future safer supply programs should be guided by evidence-based planning and implementation, drawing from successful experiences in harm reduction implementation. Implementation facilitators, in particular, evidence-based practice guidelines along with better monitoring of client outcomes can be leveraged to enhance quality of care, address client needs and preferences, and mitigate unintended harms.