Opioid dispensations: safer supply or diverted supply?

In their study evaluating opioid and stimulant dispensations for people with opioid or stimulant use disorder, Slaunwhite and colleagues state that “randomised controlled trials are rarely appropriate or feasible to evaluate real world public health interventions.”1 One reason randomised trials would fall short in evaluating this “real world intervention” is their inability to determine the extent of diversion of these “safer supply” medications.A recipient can benefit from safer supply in two ways: firstly, by having a dependable supply of drug of known dose and composition, and, secondly, by selling some of that supply, which would reduce the need to use other means for financial support (such as theft, selling sex, and so on). This second benefit is the chief concern—diversion can flood the market with inexpensive addictive drugs. This might be the reason behind reduced street prices of hydromorphone tablets, which in turn can create new users owing to widespread…
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