Early experiences and impacts of a fentanyl powder safer supply program in Vancouver, Canada: a qualitative study

Background: North America is experiencing an unrelenting overdose crisis driven by a volatile and toxic unregulated drug supply. Safer supply programs, which provide individuals with pharmaceutical-grade alternatives to the unregulated drug supply, have been implemented in various Canadian jurisdictions. While most programs provide tablet hydromorphone, the Safer Alternatives for Emergency Response (SAFER) program in Vancouver, Canada, offers pharmaceutical-grade fentanyl, including a powder formulation for witnessed consumption.Objectives: To explore early experiences among SAFER program participants receiving powder fentanyl.Methods: Qualitative one-on-one interviews were conducted with 18 (12 men, 6 women) people prescribed fentanyl powder from the SAFER program. Interview coding and analysis involved a team-based approach to identify common themes related to program experiences, focusing on impacts on unregulated drug use.Results: Most (13/18; 72%) participants reported reducing unregulated drug use since program enrollment. This was largely attributed to the SAFER fentanyl powder being effective for managing withdrawal, thereby limiting their need to access street-purchased drugs. Additionally, some participants, particularly those prescribed higher doses, suggested that SAFER fentanyl powder, unlike other safe supply medications, was a suitable alternative to street-purchased fentanyl. Participants also reported reduced overdose risk. Operating hours and dosing challenges were barriers to program engagement contributing to continued unregulated drug use for some.Conclusion: Our findings demonstrate a number of positive outcomes of the SAFER program and suggest that fentanyl safer supply has the potential to play a useful role in addressing the ongoing overdose crisis.