Safe(r) Supply: A Critical Tool in the Harm Reduction Toolkit

By Jewyl Raikes, Henry Larweh, and Sara Whaley 

Principle 2 underscores the importance of evidence-based spending but what about emerging intervention strategies? While some strategies, like medication for the treatment of opioid use disorder and syringe service programs, have become common practice, new interventions continue to emerge that show promise in combating the nation’s overdose crisis. In a time of increased volatility in the drug supply, researchers and policy makers alike have asked the question: how do we protect individuals from an unsafe illicit drug market?

Reducing harms for people who use substances is not a new phenomena, and harm reduction practices have long prioritized making communities safer—not by outright restricting substance use, but by equipping individuals with tools to make safer choices. These approaches significantly reduce the risks of overdose, infections, and other health complications associated with substance use. Looking back in history, our not so distant past can give us another example of how a regulated supply can help to reduce harms for people who use substances.

From 1920 -1933, prohibition of alcohol manufacturing, sale and transportation in the United States failed to reduce alcohol use or its associated harms. Instead, as the demand for illegal alcohol increased and black market liquor became more lucrative, the quality of alcohol declined. Bootlegged alcohol, made without proper production standards, resulted in products that could be dangerous or even deadly, or products that were contaminated with deadly substances like ethanol and methanol. During this time, crime rates soared.  

Though our current overdose crisis differs from the Temperance Movement and Prohibition, there are similarities that are worth considering. Recently, the surge of fentanyl and other contaminants have spurred conversations of regulation of the drug supply. According to the Canadian Association of People Who Use Drugs, safe supply is “a legal and regulated supply of drugs with mind/body altering properties that traditionally have been accessible only through the illicit drug market” while safer supply, as defined by the Government of Canada, “refers to providing prescribed medications as a safer alternative to the toxic illegal drug supply to people who are at high risk of overdose.”

What are the goals of safe and safer supply programs?

Both safe and safer supply programs aim to:

1. Reduce health risks from drug use, including infection prevention and addressing physical health conditions exacerbated by substance use.
2. Decrease overdose rates by ensuring consistent potency and regulated dosages.
3. Reduce reliance on the illegal drug supply by offering safer, regulated alternatives.
4. Improve overall well-being through integrated care that incorporates mental health support, and quality-of-life enhancements.

Safe and safer supply programs are designed to address the specific needs of participants by providing regulated substances alongside comprehensive social services, such as housing assistance, mental health support, and employment programs. This holistic approach ensures participants receive tailored care, increasing the likelihood of success and long-term recovery.

Challenges and Barriers

Despite the evidence, these programs face significant resistance:

• Stigma and misconceptions: Many believe that a regulated safe or safer supply enables drug use rather than mitigating its risks.
• Binary definitions of recovery: The “all-or-nothing” mindset assumes abstinence is the only goal, overlooking incremental and individualized progress.
• Lack of understanding: Misconceptions about substance use and addiction create barriers to adopting evidence-based solutions.

Adopting safe and safer supply strategies presents a critical opportunity to address this ongoing overdose crisis with evidence-based solutions. These programs not only reduce immediate harms associated with unregulated substances but also provide a pathway to long-term recovery through integrated social support services. Utilizing settlement funds to pilot safe/safer supply initiatives could serve as an essential step toward program implementation, offering policymakers and stakeholders measurable outcomes and valuable insights for future planning. By investing in these strategies, we can create sustainable systems that prioritize health, equity, and harm reduction for vulnerable communities.

Engaging in ongoing conversations on safe and safer supply with your networks can help to support advocacy. Here are some questions to facilitate discussions:

1. What similarities and differences exist between prohibition and current drug policies?
2. How can communities effectively combat stigma against harm reduction programs?
3. What role should governments and healthcare systems play in scaling safe and safer supply programs?

Jewyl Raikes, a proud Baltimore native, is a contracted Research Assistant with the Bloomberg Initiative Evaluation Team. She holds a Bachelor of Arts in Psychology from St. John’s University and a Master of Science in Health and the Public Interest from Georgetown University. In her role, Jewyl contributes to program evaluation research, emphasizing evidence-based drug policy strategies and offering insights on the allocation of settlement funds. Passionate about advancing community health outcomes and promoting health literacy, she remains deeply committed to supporting Black communities. Alongside her research work, Jewyl serves as a Program Director in the District of Columbia, where she champions the rights and well-being of individuals with disabilities through personalized services and strategic leadership.