Frishta Nafeh is a doctoral student in the Institute of Health Policy, Management & Evaluation, University of Toronto. Her research focuses on improving access and quality of healthcare for individuals with opioid use disorder. She holds a Master of Public Health degree and a bachelor’s in health policy and biology.

Background: To address the ongoing drug overdose crisis driven by unregulated synthetic opioids, select Canadian jurisdictions implemented safer supply programs, providing prescribed pharmaceutical alternatives to adults at high risk of overdose. Our qualitative evidence synthesis aimed to describe program participants’ needs and preferences to improve these programs.

Methods: Following the Cochrane Qualitative and Implementation Methods Group guidance, we conducted a systematic review and thematic synthesis of qualitative studies. We searched Medline, Embase, PsycINFO, CINAHL, EBM Reviews, Web of Science, and Scopus from January 1, 2016, to August 21, 2024. Eligible studies used qualitative data collection and analysis methods and included safer supply program participants in any health facility or setting. We used Thomas and Harden’s three-stage thematic synthesis approach to analyze data from primary studies and developed descriptive and analytic themes, following line-by-line coding. We assessed the quality of studies using the CASP checklist.

Results: Out of the 1506 unique records identified, we included 17 eligible studies which predominantly described urban men’s (61% men; 37% women) perspectives and experiences. Participants expressed the need for better opioid substitutes, flexible dosing schedules, and options for their preferred mode of consumption to optimize their ability to manage withdrawal symptoms. Participants described hydromorphone pills as an inadequate substitute for highly potent synthetic opioids they were exposed to. This coupled with restrictive clinical practices created a gap in meeting participants’ needs, thus resulting in continued reliance on illicit drugs to stave off withdrawal symptoms. Participants preferred programs that valued their autonomy, enabled shared decision making, and respected their individual goals and preferences.

Conclusions: Current safer supply programs in Canada do not fully align with client needs, goals, and preferences. Programs need to address participants’ needs and incorporate their values and preferences to enhance engagement and beneficial outcomes. Additional research is needed on non-urban settings.