MySafe is a safer opioid supply program for individuals at high risk of overdose from consumption of illegal opioids. It uses secure biometric dispensing machines to provide daily doses of physician-prescribed opioids in the form of hydromorphone tablets. A qualitative study identified participant-reported facilitators, barriers and outcomes. Facilitators included non-witnessed use, ease of access and policies that allowed participants to plan and adapt their use. Barriers included technical issues and issues related to insufficient doses and potency. Outcomes included reduced illegal drug use, decreased overdose risk and improved health and well-being for participants.
MySafe is a safer supply program that uses secure biometric machines to dispense prescription opioids to program participants. To participate, a person needs to have a history of overdose, currently use opioids and have tested positive for fentanyl in urine drug screens. Participants access their daily doses from a machine at a time they choose, and they are free to then consume their dose when, where and how they choose. The program is available at four sites: an overdose prevention site (in Vancouver) and three supportive housing sites (two in Vancouver; one in Victoria). The MySafe staff team consists of a prescribing physician and program staff at each of the MySafe locations.
Biometric machines: The machines are secure metal storage lockers similar to ATMs. A scanner identifies participants by the vein patterns of their palm, which, unlike fingerprints, cannot be linked to other identification systems. Staff at the supportive housing sites receive basic training for troubleshooting to deal with minor technical problems at night, and MySafe staff are available during the day to address more complex problems and to restock the machines. The machines are equipped with built-in cameras that record each machine interaction.
Enrolment: The prescribing physician completes a medical examination for all potential participants prior to enrolment. This includes an assessment of drug use patterns and overdose risk. This helps the physician determine eligibility for the program.
Prescription and dosage: After enrolment, the prescribing physician and participant decide on an initial daily dose of hydromorphone tablets. Dosages can be adjusted during the program; this usually happens within the first month, when drug tolerance is assessed.
Dispensing medications and filling the machines: Prescriptions are dispensed at a pharmacy and manually placed inside the machine by MySafe staff. Machines are restocked regularly to prevent interruptions in availability.
Sites and hours: Each site has one machine, and participants are assigned to a single site. Housing staff at the supportive housing sites provide 24-hour access for participants assigned to them, including any participants who do not live at the site. Access at the overdose prevention site is limited to a 13-hour period (8 a.m. – 9 p.m.).
Monitoring and support: Follow-up examinations happen at one, six and 12 months with a healthcare provider. These include urine drug screens when deemed necessary by MySafe staff (e.g., with dose increases) and assessment of medication use and outcomes. The prescribing physician monitors the drug screens and supervises staff, who provide ongoing support to participants.
A qualitative study was done between November 2021 and April 2022 to identify program facilitators, barriers and outcomes. MySafe staff recruited participants during daily work activities. A total of 46 participants were enrolled in the study.
Participant characteristics included the following:
- Median age of 41 years
- 32 (70%) identified as men
- 13 (28%) identified as Indigenous; 32 (70%) identified as white
- 36 (78%) lived in supportive housing
- 20 (43%) were receiving opioid agonist therapy (OAT)
- 40 (87%) reported using heroin or fentanyl in the previous 30 days
- 28 (61%) listed fentanyl as their preferred drug
Participants were interviewed, using guides developed with a community advisory board, which included people with lived and living experience and service providers (e.g., clinicians). Participants reported facilitators and barriers to program engagement, and program outcomes.
- Accessibility: Proximity of machines to participants’ residence and 24-hour access (at supportive housing sites) gave participants flexibility, choice and autonomy around when to access their safer supply.
- No consequences for missed doses: Some said the absence of penalties for missing a dose (e.g., being cut off, starting again at a lower dose, paperwork) reduced interruptions to their program progress and routine.
- Non-witnessed use: Some noted that choosing where and with whom to consume reduced feelings of stigma, embarrassment and judgment (e.g., from healthcare providers, pharmacists, pharmacy customers).
- Choice of how to consume (injecting, snorting, swallowing): Some said this made it possible to choose an appropriate or preferred mode for different situations (e.g., in public vs. in private).
- Contingency planning: Participants said being able to save doses allowed them to plan for expected and unexpected circumstances, such as time away, machine technical issues and days when a higher dose might be preferred.
- Technological issues: Most experienced technical issues (e.g., frozen screens, problems with palm-print scanning) at some point, though infrequently; in some cases, this led to withdrawal or led participants to seek drugs in the illegal market.
- Dosing challenges: Some said the prescribed doses were not as strong as they wished or were not strong enough for them to manage withdrawal. In some cases, this led participants to supplement the doses with drugs from other sources.
- Dedicated machine: Some said having their prescription tied to a single machine was a constraint on their mobility and/or freedom to choose where they lived or worked.
- Reduced use of illegal drugs: Most participants reported that they had reduced their use of illegal drugs. A few had stopped using illegal drugs altogether while others had reduced their use substantially. Some used illegal drugs less often; others used them in smaller doses. A few participants, whose needs were met with the prescribed medications, reported no longer using illegal drugs.
- Decreased overdose risk: This outcome was emphasized by participants, even though some reported experiencing overdoses after enrolment (most were still supplementing their safe supply with illegal drugs). Some reported less frequent overdoses after enrolment and others noted that they were simply at lower risk because they were less dependent on the illegal supply.
- Financial impacts: Many participants reported spending much less money on illegal drugs. Some said this reduced their dependence on criminalized or stigmatized sources of income and allowed them to spend their money on food or clothing.
- Improvements to health and well-being: Most participants said their health and well-being had improved, including better mood, less stress, improved relationships, more free time, better diet, functional improvements and more engagement with healthcare. Many reported that the program made it easier to manage withdrawal.
What does this mean for service providers?
Findings from this study suggest that MySafe supported participant engagement in safer supply by addressing some key challenges associated with clinic-based and pharmacy-based safer supply programs. It made safer supply highly accessible by placing it close to where people live and allowing expanded hours. It gave them flexibility and choice, enabling them to fit safe supply into their lives by choosing when to access it. It circumvented stigma and judgment by allowing them to access and consume their prescriptions without being observed. Additionally, most participants reported that they reduced their consumption of street-purchased drugs after enrolment. According to some participants, the program also reduced their risk of overdose.
Similar programs could be particularly beneficial in settings with fewer resources, services and supports. Securing funding for similar programs in diverse settings will in part depend on continued research and evaluation, including longitudinal studies using objective outcome measures and ongoing program evaluations.
Safe supply: What is it and what is happening in Canada? – CATIE evidence synthesis
Victoria SAFER Initiative – CATIE case study
Safer opioid supply (SOS) program – CATIE evidence brief
- Bardwell G, Ivsins A, Mansoor M et al. Safer opioid supply via a biometric dispensing machine: a qualitative study of barriers, facilitators and associated outcomes. Canadian Medical Association Journal. 2023;195(19):E668-76.
- Mansoor M, Foreman-Mackey A, Ivsins A et al. Community partner perspectives on the implementation of a novel safer supply program in Canada: a qualitative study of the MySafe Project. Harm Reduction Journal. 2023;20(1):1-2.
- Tyndall M. Safer opioid distribution in response to the COVID-19 pandemic. International Journal of Drug Policy. 2020; 83:102880.