Referrals can be made by an individual (self-referral) or by a healthcare provider.

Please see our Referral form here: http://hucchc.com/wp-content/uploads/2024/02/HUSS-Referral-Form-Revised-Feb-13-2024.pdf

Referrals can be submitted by:

• Fax: (905) 522-3706 (Attention: HUSS Team)
• Hardcopy: In-person drop off at 70 James St. South (at the yellow cottage in the church courtyard – off James St South) or the main HUCCHC site 181 Main St. West.

Clients accepted to the program will be under the care of a primary care provider and provided with wrap-around support from an interdisciplinary team (see list below).

Re-referrals are always accepted. We understand that an individual’s circumstances can change, and we want to remain as accommodating as possible.

Wrap-around supports/services from HUCCHC include:

• Primary Care Services (RN and NP)
• Cultural Ambassador
• Peer mentorship
• Mental Health Counsellors
• Client Advisory Committee
• Wound Clinic
• Identification (ID) clinic
• Assistance with housing, employment, and finances
• Harm Reduction supplies/Naloxone kits

The Hamilton Urban Safer Supply multidisciplinary team includes:

Manager

Project Manager

Health Navigator

Cultural Ambassador

Nurse Practitioners

Registered Nurse

Peer Mentor

1. What is the prescribed safer supply?

Prescribed safer supply uses long-established, evidence-based harm reduction models.

Doctors and Nurse Practitioners prescribe opioids to replace the unpredictable street supply of drugs. They prescribe oral hydromorphone (Dilaudid®) pills and usually also a long-acting ‘backbone’ slow-release oral morphine (Kadian® or M-Eslon®) or methadone.

2. What are the goals of prescribed safer supply?

The goals are to reduce people’s overdose risk from the unpredictable, very strong, and often lethal street supply to reduce harms related to injection drug use (HIV, Hepatitis, chronic wound infections), and to improve the health of clients.

Prescribed safer supply does not force people to use fewer drugs or to quit using drugs, it helps people stay well, stabilize, and work towards their own goals.

3. Who gets prescribed safer supply?

Safer supply is only for adults who are diagnosed as having opioid use disorder, who use street drugs, and who are at very high risk of overdose or other harms related to injection drug use. Prescribed safer supply is not for people who are new to opioids. It is a harm reduction approach for adults who already rely on the unregulated drug supply.

People prescribed safer supplies have already tried other treatments (such as OAT) and they didn’t work for them.

What safer supply medications are prescribed? How do they get them? Are they free?

People get both short-acting and long-acting opioids. Most people have drug benefits, or they pay for them directly.

• Most prescribed safer supply clients receive short-acting hydromorphone (Dilaudid®). Dilaudid® is dispensed daily. Most clients pick up a one-day supply from the pharmacy to take home and use throughout the day and night. This means they do not have to go to the pharmacy many times each day. They have time to do other things, such as work, school, or hobbies.
• Some clients do take all their Dilaudid® at the pharmacy. This happens when someone is at high risk of having their Dilaudid® lost or stolen or if there is concern about diversion. It also happens when someone has health problems that make taking opioids more dangerous.
• Most clients also get slow-release oral morphine (Kadian® or M-Eslon®) or methadone. These are both long-acting opioids that last for about 24 hours. They can help manage pain and prevent withdrawal.
• People must take their methadone and / or slow-release oral morphine at the pharmacy each day. The pharmacist watches them take it.

4. How does Dilaudid® (hydromorphone) compare to fentanyl from the unregulated street supply? Is it truly “safe”?

• No opioids are entirely safe. All opioids carry risks of overdose and risks of dependency.
• Dilaudids® are safer than street opioids because we know the strength of Dilaudid® and what’s in it.
• Dilaudid® provides similar pain relief and euphoria to heroin and fentanyl.
• How many Dilaudids® people take each day varies from client to client. Most programs have a maximum of 30 tablets per day, depending on the local unregulated drug supply.

5. What about diversion?

Diversion is when someone shares or sells their medications to other people.

• There is no evidence that prescribed hydromorphone (i.e., Dilaudid®) is contributing to drug-related deaths (British Columbia Coroner’s Office, 2023; Public Health Ontario, 2023).
• There is no evidence that the diversion of prescribed hydromorphone is occurring in schoolyards or encouraging people to start using or re-using opioids. (British Columbia Coroner’s Office, 2023).
• Prescribed safer supply programs follow evidence. We know diversion happens (like with all medications) and so far, there is no evidence that diversion is causing harm in communities.
• If research shows that there are community harms, programs will develop new strategies to ensure community safety and wellness, as needed and indicated. Safer supply providers care about the community.

6. Why does diversion happen?

• Diversion happens with all medications, including methadone, suboxone, pain medications, antibiotics, ADHD medications, sleeping pills, etc. This is not unique to prescribed safer supply medications. Diversion frequently happens between friends and family members, often in the context of caring.
• Sometimes people share their medications to help someone in withdrawal or to prevent someone from using drugs from the toxic street supply. If more people could access safer supply, people might not need to share.
• Sometimes people sell or trade their medications for food, a place to sleep, or stronger drugs. By making sure that people have access to food, shelter, and the right medication and dose, diversion might not be necessary.

7. How do programs try to prevent diversion?

• All clients are told that diversion is a reason to require observed dosing or even discharge someone from the program because of the risks to the community.
• All clients do urine tests to make sure that they are taking the medications that they are prescribed.
• All clients are told how to keep their medications safe from loss or theft, like using lockboxes.
• Doctors and Nurse Practitioners try to make sure that people are getting the medication and dose that they need.
• Social services work with clients to help them get food, income, and a safe place to sleep, when possible. We need safe housing for people.

8. What happens if diversion is suspected?

• First, doctors and nurse practitioners talk to the client about why they are diverting medications and try to address the reason, when possible.
• The client might be required to have all their medications observed at the pharmacy.
• It is crucial that all participants take their medication as prescribed. Failure to do so can have serious consequences for their health and well-being. Therefore, we have a strict policy that mandates the immediate discharge of any participant who fails to comply with their medication regimen.

9. Is there evidence that diversion is creating harm in communities?

• According to the BC Coroner’s Office: No evidence that prescribed hydromorphone is causing overdose deaths. – There is no evidence that youth are using prescribed safer supply medications.
• No evidence shows that prescribed safer supply medications are encouraging people to start using or re-using opioids.
• There are enormous amounts of evidence that shows that the powerful, unpredictable unregulated street supply is killing people.

Adapted from: National Safer Supply Community of Practice. (2023). Prescribed Safer Supply: Frequently Asked Questions. https://www.nss-aps.ca/sites/default/files/resources/2023-05-25-PrescribedSaferSupply_FAQ_NSSCoP.pdf

The Hamilton Social Medicine Response Team: https://hamsmart.ca/

Canadian Association of People who Use Drugs. (2019). Safe Supply Concept Document.

https://capud.ca/sites/default/files/2019-03/CAPUD%20safe%20supply%20English%20March%203%202019.pdf

Parkdale Queen West CHC, Toronto. (2022). Safer Opioid Supply (SOS) Program Protocols.

https://pqwchc.org/wp-content/uploads/Clinical-and-Operational-Protocols-Parkdale-Queen-West-Community-Health-Centre-June-23-2022.pdf

National Safer Supply Community of Practice. (2023). Emerging Evidence Brief on Prescribed Safer Supply and Client Experiences. https://www.nss-aps.ca/sites/default/files/resources/2023-07-25-PSSEvidenceBrief.pdf

National Safer Supply Community of Practice. (2022). Safer Supply for Health Care Providers:

https://www.nss-aps.ca/prescriber-resources

National Safer Supply Community of Practice. (2022). Resources for People Who Use Drugs

https://www.nss-aps.ca/resources-people-who-use-drugs :

Young, S., Kolla, G., McCormack, D., Campbell, T., Leece, P., Strike, C., Srivastava, A., Antoniou, T., Bayoumi, A. M., Gomes, T. (2022). Characterizing safer supply prescribing of immediate release hydromorphone for individuals with opioid use disorder across Ontario, Canada. International Journal of Drug Policy, 102, Article 103601. https://doi.org/10.1016/j.drugpo.2022.103601