'Safer supply' alternatives to toxic unregulated drug markets

Safer supply is controversial among some physicians and researchers, who have raised concerns about its limited evidence base, which includes no randomised controlled trials, and the risk of medications being diverted into the illicit market. Proponents argue that the benefits of reducing unregulated substance use through safer supply will more than compensate for any associated risks. The ongoing lack of consensus means that further evaluation is crucial. Although randomised controlled trials would offer the best evidence, they would be legally, ethically, and methodologically complex, as well as expensive and time consuming. In the context of a public health crisis, decisions must be made on the basis of currently available evidence, and further evidence must be rapidly generated.

Safer supply was introduced in British Columbia in the specific context of escalating deaths due to fentanyl and the covid-19 pandemic; however, similar interventions may reduce harms in other countries with increasing deaths from unregulated drugs. The Taliban have recently prohibited opium poppy cultivation in Afghanistan, where most of the heroin in Europe originates. This has led to a precipitous decline in production, which could result in the proliferation of more dangerous synthetic drugs. Of particular concern are nitazenes, potent synthetic opioids already being implicated in deaths across multiple European countries.

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