Building sustainability for prescribed safer supply programs to improve access to HIV and hepatitis C care
A smiling woman with a grey sweater and a smiling man wearing a toque and blue coat

June 18, 2024

By Betty Zou

In 2015, Michelle Olding moved to Vancouver to start a new job as a research project coordinator with the British Columbia Centre for Excellence in HIV/AIDS. Armed with her newly minted master’s degree in public health from the University of Toronto, she was keen to start working with local community groups to conduct community-based research on HIV.

Around that same time, Vancouver, along with communities across Canada, started seeing an uptick in opioid-related overdose deaths as a result of an increasingly toxic drug supply, prompting the BC government to declare the overdose crisis a public health emergency in 2016.

“We were losing a lot of people in our community, including a lot of collaborators. Those relationships and experiences set the course for the work that I was interested in,” says Olding, who is currently a postdoctoral fellow at U of T’s Dalla Lana School of Public Health working with professor Carol Strike.

“I really wanted to pursue a PhD and do research around better understanding and supporting harm reduction programs that are trying to address not only the overdose crisis, but also other persistent health disparities experienced by people who use drugs in Canada.”

Now, with the support of a 2024 Career Transition Award from the Emerging and Pandemic Infections Consortium, Olding is leading her own independent project looking at the role of prescribed safer supply programs in addressing the disproportionately high burden of HIV and hepatitis C among people who use drugs.

In Canada, injection drug use accounts for one in five new cases of HIV and more than half of new hepatitis C infections. Despite being at higher risk, people who use drugs experience greater challenges accessing care to prevent and treat these infections.  

The primary goal of prescribed safer supply programs is to reduce the risk of overdose deaths, but their innovative model of care has also been shown to offer secondary benefits in  improving connections to health care among the most marginalized and difficult-to-reach people who use drugs. Delivered in primary care settings, these programs provide patients at high risk of overdose with an alternative to the toxic illegal drug supply and access to wraparound supports in a low-barrier setting. These additional services often include testing and treatment for infectious diseases like HIV and hepatitis C.

“It’s a lot more than just providing safer drugs to people. They also have access to methadone [a medication that helps reduce withdrawal and cravings] and to nurse practitioners, social and peer support workers who can help navigate housing and other challenges the individual may be facing,” says Olding.

This unique comprehensive care model is effective in both saving lives and improving quality of life, but it is also resource-intensive and difficult to scale up. Olding’s research seeks to understand the different factors that contribute to making prescribed safer supply programs more sustainable and scalable.

To do this, she plans to spend time within a prescribed safer supply program to observe how they operate. She will also interview healthcare providers and patients who have been recently diagnosed with an HIV or hepatitis C infection. By better understanding their experiences within the program, Olding’s work will produce concrete data about the program’s benefits and identify challenges and opportunities related to long-term sustainability.

Her research comes at a time when prescribed safer supply programs in Canada are facing both increased demand and uncertainty about their future. Pilot funding for the programs from Health Canada’s Substance Use and Abuse Program is anticipated to end by March 2025. Olding hopes that the data from her project will inform sustainability planning for these programs as they navigate the transition from a pilot program to one that can be expanded and maintained to meet the needs of people who use drugs amid the ongoing overdose crisis.

To ensure that her work is useful and actionable, Olding engages knowledge users — like health care providers, patients and policymakers — in her research from the outset. For this particular project, she has brought onboard people with lived experience of accessing safer supply programs as collaborators and research assistants to help design and carry out the research.

“I hope that I’m able to continue working with community members and organizations to produce research that can help address those health disparities that are impacting their community and ensure that everyone has access to the health care that they deserve.”


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