Comprehensive substance use services within primary care settings: The Safer Opioid Supply program at London...

This paper describes the Safer Opioid Supply (SOS) program, a public health intervention in London, Ontario, in response to the toxic unregulated drug supply which is driving the overdose crisis in Canada.

The London InterCommunity Health Centre (LIHC) SOS program provides comprehensive harm reduction and primary health care services to individuals at risk of overdose from the toxic drug supply. Clients are prescribed high-dose pharmaceutical opioids as replacement for unregulated toxic substances within a low-barrier primary care clinic, with wraparound interdisciplinary social services, embedded in the Ontario Community Health Centre model of care. The program serves people dependent on street-acquired fentanyl who are experiencing medical issues due to their substance use, and who are experiencing challenges accessing other forms of healthcare.

A qualitative analysis of interviews and focus groups conducted in 2022-2023 with staff (n=5) and clients (n=20) was used to explore impacts of the SOS program. Four outcomes are discussed: safer supply as crucial to engage clients in primary care; safer supply as one component of comprehensive care; the use of a harm reduction approach; and challenges with limited medication options and program capacity.

Positive health and social outcomes demonstrate the utility of embedding comprehensive substance use services within a primary health care model to address health and social complexity among people who use drugs amid the continuing toxic drug crisis. Responding to an increasingly volatile unregulated supply of drugs, having limited medication options, and providing comprehensive care without long-term funding remain ongoing challenges.