By Alexa Norton, Andrew Ivsins, Elizabeth Holliday, Christy Sutherland, Thomas Kerr, Mary Clare Kennedy

Background: The ongoing overdose crisis in Canada has prompted efforts to increase access to a “safer supply” of prescribed alternatives to the unregulated drug supply. While safer supply programs predominantly distribute hydromorphone tablets, the Safer Alternatives for Emergency Response (SAFER) program in Vancouver, Canada offers a range of prescribed alternatives, including fentanyl patches. However, little is known about the effectiveness of fentanyl patches as safer supply. Drawing on the perspectives and experiences of program participants, we sought to qualitatively evaluate the effectiveness of the SAFER fentanyl patch program in meeting its intended aims, including reducing risk of overdose by decreasing reliance on the unregulated drug supply. Methods: As part of a larger mixed-methods evaluation of SAFER, semi-structured qualitative interviews were conducted with 17 fentanyl patch program participants between February 2022 and April 2023. Thematic analysis of interview data focused on program engagement, experiences, impacts, and challenges. Results: The flexible program structure, including lack of need for daily dispensation, the extended missed dose protocol, and community pharmacy patch distribution fostered engagement and enhanced autonomy. Improved management of withdrawal symptoms and cravings due to steady transdermal dosing led to reduced unregulated drug use and overdose risk. Participants also experienced economic benefits and improvements in overall health and quality of life. However, skin irritation and patch adhesion issues were key barriers to program retention. Conclusion: Our findings demonstrate the value of including fentanyl patch safer supply in the substance use continuum of care and offer insights for innovations in delivery of this intervention.

International Journal of Drug Policy Volume 131, September 2024, 104547

By Andy Hochstetler1,2, David J. Peters1, Kyle Burgason1, Jeff Bouffard1, Glenn Sterner III3, Shannon Monnat

Introduction: The goal of this project was to identify rural jurisdictions with high drug overdose rates and collaborate with resourced mentors to create law enforcement intelligence responses to local opioid problems. Methods: The first part of the strategy was to control for known contributors to opioid death that are largely beyond the control of law enforcement, and thereby focus on jurisdictions that are outliers in terms of drug problems. (Work products include a Non-Metropolitan County Opioid Overdose Calculator that allows one to examine how demographics and other county conditions affect overdose risk.) Use of maps of drug overdose deaths identified high overdose places by drug type with a classification technique to group places with like drug problems (latent profile analysis) and a multiple regression data analysis to identify outliers. A survey of law enforcement agencies provided an understanding of intelligence resources available in rural areas and agencies. This information informed recruitment of enthusiastic participant agencies. A small scale, intelligence strategy appropriate to resource deprived, rural departments was developed in collaboration with participating agencies, leaving them great flexibility in design. Evaluation of outcomes included a survey, qualitative interviews providing anecdotal feedback, and official data that each department had decided would speak to successful implementation. Conclusions: Variables significantly predicting death rates include population, indicators of ethnic diversity, natural resource amenities, and labor market characteristics. Lagged indicators of drug deaths and prescribing rates are the most consistently significant and convincing block of variables as predictors of current death. The most successful departments implemented efforts based on what they had learned in previous collaborations with better resourced areas, where efforts led to arrests and judges supported use of intelligence in court proceedings, and either information sharing or use of electronic surveillance was supported such as using cell phone opening software. Also, closed network iPads were used in relation to controlled buys, search warrants, pre and post raids, evidence and picture recording during searches, overdose mapping, surveillance photos and messaging to the narcotics officer, confidential informant files and referencing files, and notes from scenes. ODMAP can inform efforts but proved difficult to use on mobile devices, lagging in time, and imprecise to use as daily actionable intelligence. Funds can be well spent in rural places, but investments in departments with little resource slack, lacking in administrative capacity, and where there are few personnel or hours of investment to spare are risky and make for difficult collaborations. Analytics and predictive problem solving are near impossible. Therefore, immediate and accessible intelligence for patrol officers without investment in analytics likely should be the goal.

Ames, IA: Iowa State University, 2023. 71p.