COVID-19 and Mental Health (CMH) Initiative: Research

Securing Safe Supply During COVID-19 and Beyond: Scoping Review and Knowledge Mobilization

Key Messages

  • Restrictive laws and fear of discipline by professional bodies appear to limit access to safe supply.
  • Facilitators such as regulatory exemptions are insufficient by themselves, to improve access to safe supply.
  • In some respects, there is broad agreement between the literature reviewed and PWUD expertise whereas, in other cases, there is a disconnect between the bodies of knowledge about the barriers to implementing safe supply. To ensure this disconnect does not misdirect resources toward initiatives that do not respond to the barriers that are encountered, PWUD should be represented and integrated directly into efforts to improve access to safe supply.

Lay Summary

Literature searches yielded 39 studies that meet our inclusion criteria. Thirty-three (33; 85%) were identified through our searches of published literature and 6 (15%) through a grey literature scan. Of these, the highest proportion were commentaries (18; 46%), qualitative studies (12; 31%), or reports (4; 10%). The remainder were mixed methods studies (3; 8%), guidelines (1; 3%), quantitative studies (1; 3%) and peer reviewed reports (4; 10%).

A series of preliminary themes related to barriers and facilitators of safe supply were identified in the reviewed studies and assessed in collaboration with PWUD involved in the project. The main preliminary barriers to safe supply identified were: restrictive laws or policies, manufacturing policies or practices, limited prescribing power or prescribers, distrust towards institutions, concerns about drug harms, concerns about evidence, and a variety of practical barriers. PWUD significantly enlarged our understanding of the barriers to safe supply, emphasizing the intersection of racism with stigma/discrimination connected to drug use while also pointing to over-medicalization of safe supply related programs and other factors such as child apprehension by social works and a lack of cultural competency as important additional barriers.

While not a primary focus of the synthesis, the literature used various alternative terms to refer to safe supply. Discussions among PWUD involved in this project further highlighted the inconsistent use of the term.


  • Heroin
  • Hydromorphone
  • Oxycodone
  • Morphine
  • Pandemic
  • Influenza
  • Diacetylmorphine
  • COVID-19
  • SARS
  • Safe supply


  • Nominated Principal Applicant: Matthew Herder, Director, Health Law Institute, Schulich School of Law, Dalhousie University; Associate Professor, Department of Pharmacology, Faculty of Medicine, Dalhousie University
  • Matthew Alexander Bonn, Program Coordinator, Canadian Association of People Who Use Drugs
  • Natasha Touesnard, Executive Director, Canadian Association of People Who Use Drugs
  • Michael Pugliese – Research Assistant,  Dalhousie University, Faculty of Medicine, Halifax, Nova Scotia
  • Brianna Cheng – Research Assistant, MSc, McGill University, Department of Epidemiology, Biostatistics and Occupational Health, Montréal, Canada
  • Emilie Comeau – Research Assistant, Dalhousie University, Faculty of Medicine, Halifax, Nova Scotia
  • Dr. Claire Bodkin – McMaster University, Family Medicine, Hamilton, Canada
  • Dr. Tommy Brothers – Dalhousie University, Faculty of Medicine, Halifax, Nova Scotia.
  • Dr. Leah Meghan Genge – Dalhousie University, Dept of Family Medicine; Mobile Outreach Street Health – North End Community Health Centre
  • Candis Lepage – Research Analyst, Pier Labs, Halifax, Nova Scotia.
  • Dr. Ayden Scheim – Assistant Professor, Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University.
  • Dr. Daniel Werb – Assistant Professor, Division of Infectious Diseases & Global Public Health, University of California San Diego; Institute for Health Policy, Management & Evaluation, University of Toronto; Director, Centre on Drug Policy Evaluation, St. Michael’s Hospital, Toronto.
  • Sheila Wildeman – Associate Professor, Schulich School of Law, Dalhousie University

For more information, please contact: Matthew Herder, Matthew.Herder@Dal.Ca

Related Syntheses


Full PDF


People Who Use Drugs (PWUD) and Substance Use


To ensure the rapid dissemination of this critical information, information is published in the language in which it was submitted. Please contact us for French or English translations.

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