The objective of this environmental scan is to summarize evidence on the health and social impacts of safer supply programs. This scan will also describe local, provincial/state, national or international examples of safer supply models. Safer supply programs of interest include those that provide a predictable source of a substances as an alternative to the street supply: opioid programs (e.g., unsupervised or supervised consumption of prescribed hydromorphone [HDM]), and non-opioid programs (e.g., stimulants, benzodiazepines). For context, the evidence review will synthesize review-level evidence of effectiveness of opioid agonist treatment (OAT) (e.g., methadone, buprenorphine) and injectable opioid agonist treatment (iOAT) (e.g., injectable hydromorphone, diacetylmorphine), and other opioid and non-opioid programs that provide pharmaceutical medications for substance use in a treatment model. The jurisdictional scan will focus on programs and models of safer supply programs (e.g., HDM tablets programs, or access to non-opioids such as stimulants), distinct from the OAT and iOAT treatment models. 

Key findings:

• Various options are emerging for people who use unregulated drugs to secure access to a regulated drug supply, including prescriber-based models, with or without a comprehensive program, and non-prescriber based models (e.g., compassion clubs, grassroots supply). Safer supply models are an approach to provide an alternative to the toxic unregulated supply.
• To date, there is little published literature on the outcomes of safer supply programs, but several evaluations are in progress. There is also little published evidence on non-prescriber models or safer supply models that are not part of a comprehensive program. Early evaluations of prescriber-based safer supply programs in Canada have been published and have reported increased connections to wrap-around supports, reduced reliance on an unregulated drug supply, and reduced engagement in criminal activity among participants.
• The jurisdictional scan identified and summarized ten safer supply programs and seven policy/program guidance documents in Canada, providing an overview of some of the current safer supply landscape. Information from these sources on the outcomes of safer supply programs in Canada report the following among participants: low rates of fatal overdose, increased engagement in health care and social supports, improved mental health and sleep patterns, reconnection with family, and an ability to exert control over their drug use.
• As treatment options, there is a well-established body of evidence that opioid agonist treatment (OAT) and injectable opioid agonist treatment (iOAT) are effective across several health and social outcomes including treatment retention, decreased use of drugs from an unregulated supply, less engagement in criminal activity and increased access to healthcare. Decreased risk of all-cause and opioid-related mortality has been demonstrated for OAT. 
• Early evidence from Ontario and British Columbia suggests that prescription-based safer supply may be a viable option for those who do not tolerate, use, or desire available treatments as well as those who use drugs from an unregulated supply in addition to OAT. There are ongoing evaluations of several safer supply programs in Ontario and British Columbia, with results expected in 2022-23. Further research is recommended to support evidence informed decisionmaking on safer supply options, doses, and delivery methods.