Safer opioid supply initiation among First Nations Peoples in Ontario, Canada, 2019 to 2023

Indigenous-led initiatives to improve access to opioid use disorder (OUD) treatment and harm reduction are helping transform care and safety for First Nations Peoples. Safer opioid supply (SOS) involves the provision of pharmaceutical-grade opioids as an alternative to the unregulated drug supply. We sought to examine trends and characteristics of First Nations Peoples initiating SOS in Ontario, Canada. We conducted a population-based cross-sectional study of registered First Nations Peoples in Ontario with OUD, who initiated SOS between January 1, 2019 and December 31, 2023. We reported the number and rate of SOS initiations per 1000 First Nations Peoples annually, and characteristics for 2023, including sex, age (15–24, 25–44, 45–64, 65+ years), and residence in urban vs. rural regions and within vs. outside of First Nations communities The annual rate of SOS initiations among First Nations Peoples increased dramatically between 2019 and 2023 (0.11 to 0.65 per 1000; N = 15 to 92). In 2023, SOS initiation was similar between males and females (0.69 vs. 0.61 per 1000), with the highest rate among those aged 25–44 years (1.32 per 1000; N = 71). Most SOS initiations were among individuals residing outside vs. within First Nations communities (0.90 vs. 0.13 per 1000) and urban vs. rural regions (1.05 vs. 0.13 per 1000). Overall, the rate of First Nations Peoples accessing SOS in Ontario increased almost five-fold, demonstrating growing engagement with this harm reduction approach. Future research is needed to understand First Nations People’s experiences with SOS, and the impacts of program closures across Canada.