Charlotte Boone, RPh, PharmD1,2
Mark Barnes, RPh, BScPhm1
Maria Zhang, RPh, BScPhm, PharmD, MSc.2,3
Beth Sproule, RPh, BScPhm, PharmD2,3
1 Respect Rx Pharmacy, Ottawa, Ontario.
2 Centre for Addiction and Mental Health, Toronto, Ontario.
3 Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario.
In 2020 there were 6,214 opioid-related deaths across Canada , with 2,426 (39%) taking place in Ontario.  Over the course of the COVID-19 pandemic, there was an almost 80% increase in opioid-related deaths in Ontario when comparing rates in February and December 2020. 
“IN 2020 THERE WERE 6,214 OPIOID-RELATED DEATHS ACROSS CANADA”
These deaths are overwhelmingly accidental and preventable, with fentanyl and fentanyl analogues directly contributing to almost 90% of the deaths.  Opioid agonist treatment (OAT; e.g., methadone, buprenorphine, slow-release oral morphine) is an evidence-based intervention that consistently demonstrates effectiveness in reducing mortality in individuals with opioid use disorder, even in the fentanyl era. [3,4] However, barriers to treatment access, engagement and retention exist, therefore, complementary harm reduction strategies are also essential. Harm reduction services that prevent opioid-related deaths include safe consumption sites, drug checking services and take-home naloxone kit provision. Safer opioid supply (SOS) programs have expanded over the past year in efforts to prevent overdoses and overdose deaths secondary to an unknown and increasingly toxic illegal drug supply, by providing low barrier access to pharmaceutical opioids of known doses and quantities to people at high risk of opioid-related harms. Safer supplies can also include stimulants or benzodiazepines; however, this article focuses on 5 things pharmacists should know about SOS programs in the context of the opioid crisis.
1. Safer supply aims to offset the toxic illegal drug supply and reduce harm.
2. Safer opioid supply is different from opioid agonist treatment.
3. Dispensing guidance is currently based on clinical experience.
4. Pharmacists have a key role in supporting participants of safer opioid supply programs.
5. Transitions in care must be managed carefully.
In caring for all clients, and in particular those who continue to experience systemic oppression, pharmacists must aim to provide clients with a non-judgmental, compassionate, respectful and safe environment that is free of stigma. It is highly recommended that all pharmacists undertake training in opioid use disorder to ensure an understanding of the nature of addiction and to reflect on their own biases and stigmatizing behaviours. There are several resources available, for example, the CAMH Opioid Use Disorder Treatment course  and the ‘Overcoming Stigma – Online Learning’ provided by the Canadian Centre on Substance Use and Addiction.  Safer supply programs provide people with a safer avenue to obtain opioids. Ultimately, clients should guide their goals of care and pharmacists should provide a supportive, inclusive environment. Research evaluating this harm reduction approach is underway and will help develop the evidence-base needed to guide future practice.