An Ethical Analysis of Safe Supply

Abstract

Opioid overdose deaths in the United States have been steadily increasing for decades. Initially, these deaths were driven by overdoses from prescription opioids. Strict limits were placed on opioid prescriptions to decrease the supply of available opioids. Instead, this prompted a shift toward the illicit opioid market, causing an increase in heroin-related overdoses. Fentanyl, a synthetic opioid that is more potent than heroin, has become commonplace in the illicit supply of opioids. The illicit opioid market is unregulated and unpredictable, and there is no way to know exactly what is in a bag sold as heroin or “dope”. Illicit drug use has been historically dealt with as a crime rather than a public health issue in the United States. Recently, harm reduction has been offered as an alternative to this punitive approach. Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. Naloxone distribution and syringe service programs are examples of currently utilized harm reduction strategies in the United States. While these programs are necessary to improve the quality of life of people who use illicit drugs, the rates of death from overdose are continuing to increase. These strategies do not protect people from the toxic and unpredictable drug supply. Safe supply is a relatively new concept, but there have been some small-scale implementations of this practice in Canada. Safe supply refers to a legal and regulated supply of drugs with mind and body-altering properties that traditionally have been accessible only through the illicit drug market. This is a necessary strategy to combat the alarming rise in overdose mortality. In this paper, I will analyze the ethics of this strategy using a principalism approach. This analysis concludes that safe supply is ethically sound, and it should be a part of our approach to the overdose epidemic. Safe supply promotes autonomy, prevents harms, advances well-being, and upholds justice for people who use drugs.