This edition of Research As It Happens features a conversation with Farihah Ali, PhD, Scientific Lead, Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH) and Manager of the Ontario Canadian Research Initiative in Substance Misuse (CRISM) Node Team. Dr. Ali is co-leading a project that is looking at ways to reduce the risk of overdose and improve the health and social outcomes of people with substance use problems.
What is this research about?
This research explores the impact of safer supply programs (SSPs) on people who use drugs (PWUD) in Ontario. SSPs provide pharmaceutical-grade opioids and stimulants as a safer alternative to toxic street drugs. The aim is to reduce the risk of overdose and improve the health and social outcomes of people with substance use problems.
Due to policy changes and funding uncertainties, a number of SSPs across Ontario face the risk of closure. Therefore, we are conducting a study to understand the effect of such closures on the clients’ health, well-being, and access to services. The study will also ask them what strategies they are using or plan to use in response to these closures. By amplifying their voices, this study aims to shed light on the realities of people who use drugs and inform policy and decision-making.
Who is conducting this research?
The leads of this work are Drs. Jürgen Rehm and Farihah Ali from the Ontario CRISM Node at the Centre for Addiction and Mental Health (CAMH). The Node is part of the Canadian Research Initiative in Substance Matters, a national research network that supports evidence-based strategies focused on substance use and harm reduction.
People with lived experience contributed to the study design and recruitment efforts, and select SSPs across Ontario were partners in the recruitment process.
Where is this study being done?
Dr. Farihah Ali: We are conducting the study using a video platform or phone calls to interview clients.
Who are the study participants?
Dr. Farihah Ali: The 25 participants in the study are current clients of six SSP in regions across the province and have diverse backgrounds, ages, genders, and racial identities. Many have experienced homelessness or housing instability and used unregulated drugs before enrolling in a SSP. These clients have provided critical insight into the impacts of SSPs and the implications of their closure.
What study methods did you use?
Dr. Farihah Ali: Each client in the study participated in a 30- to 60-minute phone or video interview. These followed a semi-structured format, which includes open-ended questions that allow the researcher to engage the client in a discussion and explore themes.
In addition to describing their experiences with their SSP, study participants provided information on their age, gender, ethnicity and other sociodemographic details, their drug use history, mental health and substance use services they accessed. This information will help contextualize the study findings. All interviews were audio-recorded, transcribed, and analyzed for recurring themes and patterns.
What do you hope to achieve with this research?
Dr. Farihah Ali: Our team aims to put a spotlight on the voices of SSP clients, the impact of SSPs on their lives, and the potential consequences of program closures. The study will document the effects of SSPs on drug use behaviours, health outcomes, and social stability while identifying risks associated with closures. By sharing the real-life experiences of SSP clients, we hope our findings will inform harm reduction policies, public health initiatives, and advocacy efforts, and challenge misconceptions.
What are the limitations of your study?
Dr. Farihah Ali: With a sample size of 25 participants from Ontario SSPs, our findings may not fully represent the experiences of all SSP clients, especially those from other regions of Canada. In addition, data is based on personal experiences rather than clinical records. Finally, this study captures experiences at a single point in time and does not track long-term impacts. Future research should include longitudinal studies to understand the long-term impacts of closures.
What will the research potentially add to the sector?
Dr. Farihah Ali: We believe that this research will provide evidence of the benefits of SSPs and the harms caused by their closures. By presenting the real-world experiences of SSP clients, we hope our findings will support advocacy efforts and inform policy discussions by showing that SSPs reduce overdose deaths, improve health outcomes, and support social stability. In addition, we believe the insights from our study will help harm reduction providers identify areas where additional resources are needed.
An additional aim of the research is to reduce stigma by sharing personal stories, contributing to the growing body of harm reduction evidence.
Are there any identifiable future areas to build on this research?
Dr. Farihah Ali: Future research should explore the long-term impacts of SSP closures, tracking changes in participants’ drug use patterns, overdose risks, and healthcare interactions. It is also vital to examine how closures affect healthcare systems, emergency services, and social support organizations. An economic analysis also would provide evidence on the cost-effectiveness of SSPs compared to the financial burdens of untreated opioid use, hospitalizations, and law enforcement costs.
Are there any future areas you would like to explore once this study is over?
Dr. Farihah Ali: Future research could explore broader community impacts following SSP closures, such as changes in public health outcomes, crime rates, and emergency service use. Investigating innovative harm reduction models, including community-led and peer-led safer supply programs, could identify alternative solutions. Examining the role of peer support networks and how they function without formal programs could also offer insights into community-based harm reduction approaches.