QUESTION What are the values and preferences of safer opioid supply clients?

STUDY SELECTION AND ANALYSIS We conducted a systematic review of qualitative studies on safer opioid supply client experiences published between January 2016 and August 2024. Searches were conducted across seven databases-MEDLINE, Embase, PsycINFO, CINAHL, EBM Reviews, Web of Science and Scopus-and supplemented with searches in Google Scholar and relevant repositories. Study quality was assessed using the Critical Appraisal Skills Programme. Data analysis was guided by Thomas and Harden's thematic synthesis approach and confidence in review findings was evaluated using Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative research. The review was registered with PROSPERO (CRD42022384447).

FINDINGS Our thematic synthesis included 19 peer-reviewed original research articles involving 459 study participants from British Columbia and Ontario, of whom 60.1% were men and 36.1% were women. Our findings centred on four cross-cutting analytic themes: (1) client-relevant goals and outcomes (withdrawal management, pain management, socioeconomic improvements), (2) the right medications to optimise client-relevant outcomes (multiple medication and formulation options, flexible dosage), (3) supportive, client-centred care environment (safe, welcoming and non-judgmental spaces, coordinating access to health and social support services, shared decision-making) and (4) complex adaptive systems approach to clinical policies (understanding the complexity of clients' living circumstances, flexible dose schedules, non-punitive policies). Confidence in findings ranged from moderate to high.

CONCLUSIONS Safer opioid supply's success depends on providing individualised opioid medications, fostering person-centred care and implementing adaptive clinical policies. A supportive and flexible model enhances client satisfaction, sustains programme participation and optimises client-relevant outcomes.