Safer supply program enrollment motivations and medication preferences among people who use drugs in Vancouver, Canada

OBJECTIVES: Safer supply programs have been implemented in Canada as part of the response to the ongoing toxic drug crisis. Established in 2021, the Safer Alternatives for Emergency Response (SAFER) program in Vancouver, Canada, offers a range of prescribed pharmaceutical alternatives to the unregulated drug supply, including fentanyl products for witnessed use. The present study sought to characterize SAFER program enrolment motivations and safer supply medication preferences among SAFER participants. METHODS: Between December 2021 and February 2025, cross-sectional data were collected from a prospective cohort of SAFER program participants via baseline interviewer-administered questionnaires. Descriptive statistics were used to examine self-reported reasons for enrolling in SAFER and safer supply medication preferences. RESULTS: Among 96 participants, 26 (27.4%) identified as women or gender diverse. The most frequently cited reasons for SAFER program enrolment were: to reduce unregulated drug use or related harms (70.8%); and to improve general health, stability or social wellbeing (53.1%). The most commonly preferred safer supply medications were fentanyl powder (48.3%) and injectable diacetylmorphine (25.8%). Overall, 39 participants (43.8%) were currently prescribed their preferred medication. After fentanyl powder was introduced at SAFER in March 2022, this proportion increased from 19.4% to 56.9%, p < 0.001. DISCUSSION: The primary reported motivations for program enrolment - reducing unregulated drug use or related harms and improving health and wellbeing - mirror the core stated objectives of SAFER, suggesting program alignment with participant goals. Observed improvements in receipt of preferred medications over time highlight the value of expanding and adapting medication options in alignment with participant needs.