The Safer Opioid Supply (SOS) program of the London InterCommunity Health Centre (LIHC) offers comprehensive substance use services embedded within a primary care model in London, Ontario. By prescribing pharmaceutical alternatives to the toxic unregulated drug supply and providing wraparound healthcare and social supports, the program aims to reduce the number of overdoses and deaths, and to improve health and social outcomes for people who use drugs. A recent qualitative study found that the SOS program is crucial for supporting people who use drugs by (1) engaging clients in primary care through safer supply, (2) delivering comprehensive care that integrates medical, social and harm reduction supports and (3) fostering trust and a non-judgmental environment grounded in harm reduction. The qualitative study also identified structural barriers that limit the impact of the program.
Program description
The LIHC SOS program is a primary care-based model for providing individualized prescriptions of SOS alongside traditional opioid agonist therapy (OAT) medications to individuals at risk of overdose from the toxic drug supply. Owing to the limited space within the program, priority for admission is given to people facing the highest health and social risks, including those who are unhoused, engaged in sex work, living with untreated HIV or recently hospitalized for drug-related complications.
Clients of the program receive prescriptions alongside low-barrier, trauma-informed wraparound interdisciplinary supports, including access to health and social supports. The SOS team includes physicians, nurse practitioners, social workers, community workers and care facilitators. All clients are registered with the primary care service of the LIHC, ensuring continuity of medical care and access to physicians and nurse practitioners. Wraparound health services range from preventive and acute medical care to infectious disease treatment, sexual and reproductive healthcare, testing of and treatment for sexually transmitted and blood-borne infections (STBBIs), wound care and referrals to specialist health services (among others).
For social supports, care facilitators, social workers and community workers offer harm reduction education and supplies (e.g., sterile drug use equipment, naloxone), housing and income supports, assistance with transportation, appointment accompaniment, identification clinics, access to food and hygiene supplies, systems navigation and advocacy, counselling and community referrals (e.g., withdrawal management, residential treatment programs).
Once enrolled, clients start off attending the SOS program two to three times per week until their medication doses are stabilized. They attend on a weekly or biweekly basis after that to receive comprehensive primary care and have their medications adjusted as necessary. Most clients receive daily-dispensed medications, with long-acting opioids provided as witnessed doses at pharmacies, and hydromorphone provided as take-home doses.
Previous research has shown that the LIHC SOS program has led to improvements in health outcomes for clients. Studies have found reductions in the number of overdoses, decreased use of drugs from the unregulated supply and reduced use of drugs by injection. Clients have also experienced significantly lower rates of emergency department visits and hospitalizations.
Results
In-person interviews and focus groups with 20 SOS program participants were conducted in June 2022, and interviews with five SOS program staff were conducted online between November 2022 and February 2023. Findings demonstrated that combining medical treatment with harm reduction and social support within a primary care setting can foster more compassionate and effective services for people who use drugs. Study findings revealed four major themes.
Providing safer supply engages clients in primary care
Staff observed that access to safer supply medications helped clients build and maintain consistent engagement with their health care. Through regular primary care visits, clients were able to attend to both their physical and mental health concerns, while the program’s on-site social supports contributed to greater stability in areas such as income, nutrition and housing.
“We have some folks who have never engaged with a medical system before, I would say sometimes in their whole life. And having a person, you know, engaged in a medicalized model of safe supply where they come into a medical clinic, they meet with a nurse, they talk about their substance use as well as their physical primary care, chronic or acute medical concerns, and then see a doctor regularly, I think that engagement with the medical system is such a great way for us to help our folks treat some of those really important and really life threatening ailments like sepsis. Like abscess. Like endocarditis.” (LIHC staff member)
Many clients reported that before entering the program they relied on unregulated fentanyl and engaged in survival activities such as sex work or street-based income generation to manage withdrawal or pain. After having access to a consistent, pharmaceutical-grade alternative, clients reported being able to stop these activities and experiencing fewer overdoses. SOS medications created space and opportunity for clients to focus on rebuilding their personal stability and relationships that mattered to them.
“It gives me back my life. I can go do things.” (LIHC client, interview)
Safer supply can support broader comprehensive care
Clients described how combining safer supply with access to medical and social supports helped them make progress toward stability, manage pain and address long-standing health issues. Health and social care providers developed trusting relationships with SOS participants, which enabled them to address a range of social and health issues alongside substance use goals. Together, they set individualized goals, which ranged from pursuing abstinence or reducing street drug use to stabilizing on prescribed medications, accessing medical care, reconnecting with family, continuing education or maintaining employment.
“I never had a doctor period. I had so much health issues it was crazy. It just, it saved my life in EVERY aspect. From showering to eating.” (LIHC client, interview)
“...we’re a full multidisciplinary clinic. So on top of primary care, we do have case facilitation dedicated to our [safer supply] program which is a case manager. We have systems navigation and within our [community health centre] we have access to social work, psychiatry, physiotherapy, dietician, foot care. We have infectious disease teams on staff for [hepatitis C] and HIV-AIDS. So they have access to absolutely all of that within the centre. Our [safer supply] program is just one, one tool that we use within our primary care lens.” (LIHC staff member, interview)
Providing safer supply fosters trust and a non-judgmental environment through a foundation of harm reduction
In contrast to previous experiences of stigma within health systems, clients reported feeling respected and cared for. From the staff at reception to the physician prescribers, clients stated that every team member contributed to creating a welcoming, non-judgmental environment rooted in harm reduction. High retention and engagement demonstrated safety and trust in the program. Staff reported that SOS program participation often marked the first sustained connection to healthcare for clients who had previously avoided or been excluded from traditional medical systems.
“It’s the best place I’ve ever been. I feel like this is my home. Like, I come in here, they know me. They know my name. You know? [...] It just makes me feel like they give a shit. They’re not just pumping me full of drugs and getting me the fuck outta here. It makes me want to be a better person, you know?” (LIHC client, interview)
“...I think that our model of care works really well. That harm reduction client focused care. That they lead their own health care. Their own social care. They identify what they feel their needs and wants are. And we help them with that, as they’re ready to approach each task, or step in their life.” (LIHC staff member, interview)
Structural barriers limit impact
Both clients and staff highlighted that there are two structural factors — limited SOS medication options and a lack of long-term funding — that limit the impact of the SOS program. Clients noted that limited medication options meant that their needs were not fully addressed, especially for those with higher opioid tolerances and those who prefer smokable alternatives to oral tablets of hydromorphone.
“Cause once you get to fentanyl it’s almost like nothing else works for them. Like, seems like that. You know? Seems like the end of the rope, you know? Like the road there. It’s like you can’t get anything that’s gonna make you feel better. So, what do you do, right? So I think a safe supply of it [fentanyl], yeah. It would help them.” (LIHC client, interview)
Staff underlined that current provincial formularies restrict access to a wider range of pharmaceutical opioids, including smokable formulations that could better reflect actual drug use patterns. Staff also noted that capacity and resource constraints meant that the program could allow only a fraction of the eligible community members to participate, leaving many without access. Staff cited that short-term funding cycles exacerbated these limitations and instability, often creating uncertainty for both clients and staff and limiting longer term planning and program expansion.
“I think medication legislation is a barrier to us. That’s what is no longer working well where it once did. Having access to other medications and alternative medications would help us scale up in a really large way.” (LIHC staff member, interview)
What does this mean for service providers?
This study highlights the importance of integrating harm reduction, safer supply and primary care within a comprehensive, wraparound model of support. It shows that programs like SOS can successfully engage people who use drugs in care that addresses their medical and social needs when services are low-barrier, non-judgmental and grounded in trust. However, this study underscores the structural challenges, such as limited medication options, capacity constraints and the need for sustainable funding to maintain and expand these approaches.
Related resources
Use of fentanyl patches in a safer supply program – CATIE article
Safer opioid supply (SOS) program – CATIE article
Victoria SAFER Initiative – CATIE case study
CATIE statement on safer supply – CATIE statement
Reference
Fajber K, Sereda A, Warren S et al. Comprehensive substance use services within primary care settings: the Safer Opioid Supply program at London InterCommunity Health Centre. Canadian Journal of Public Health. 2025;116: 408-17. Available from: https://doi.org/10.17269/s41997-025-01006-8