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In contrast to the hoped-for benefits outlined by Klaire and colleagues (CMAJ May 16, 2022), two recent reviews have raised concerns about the public supply of addictive drugs (PSAD), known by proponents as “safe supply.”1,2 The Stanford-Lancet Commission warns against “converting the system to unmonitored, long-term prescriptions on a take-home basis.” 1
Over 50 years of drug market economy studies have shown that cost, availability, perception of harm, and financial incentives influence drug use behaviours. 3 PSAD eliminates cost, increases availability, decreases harm perception, and incentivizes drug use and diversion.
Other concerns include exploitation of vulnerable people to sell their supply, serious infections from the injection of tablet formulations of medication, increased access for youth, enticing people from treatment, financial and manpower costs, and creating the next wave of opioid crisis.1,2,3
Portugal has gone from the country in Europe with the highest to the lowest drug overdose rate without the use of PSAD. Instead, they decriminalized personal substance use and made it an administrative offence allowing in-person assessment, offered housing, medical care, substance treatment, and vocational rehabilitation. 4 Death rates have plummeted along with homelessness, HIV, incarceration, and unemployment.
In Canada, we need to improve prevention, early intervention, and treatment options (including opioid agonist and antagonist m...
Show MoreCompeting Interests: None declared.References
- 1. Humphreys K., Shover C.L., Andrews C.M., et al Responding to the opioid crisis in North America and beyond: recommendations of the Stanford-Lancet Commission. Lancet 2022;399(10324):555-604.
- 2. Moniruzzaman A, Rezansoff S, Sobey P, Somers J. A public supply of addictive drugs: a rapid review. SFU 2022. http://www.sfu.ca/carmha/publications/psadrr.html
- 3. Caulkins JP, Nicosia N. What economics can contribute to the addiction sciences. Addiction. 2010;105(7):1156-1163.
- 4. Portuguese Government. (1999). Portugal’s National Drug Strategy 1999 (English version). http://www.emcdda.europa.eu/drugs-library/portugals-national-drug-strategy-1999-english-version_en
- 5. Exemption from controlled substances act: personal possession of small amounts of certain illegal drugs in British Columbia (Jan31, 2023 to Jan 31, 2026). Government of Canada. https://preview.tinyurl.com/24oj2y48