HARM REDUCTION
PRESCRIBED ALTERNATIVES & OUTREACH (PAO)
Prescribed Alternatives are a regulated and safer opioid option to the unpredictable and toxic street supply. The objective of this program is to enhance the quality of life for individuals, while reducing the risk of overdose, hospital admissions, emergency room visits, and involvement with the criminal justice system.
The program offers comprehensive wrap-around care, which includes primary health care, addiction care, case management, housing and income support, sexual health testing, and treatment facilities. The Prescribed Alternatives program aims to provide individuals with the necessary tools and resources to live a healthy and fulfilling life, while minimizing the negative impact of opioid addiction.
Frequently Asked Questions
Find answers to commonly asked questions about our PAO programs and services.
What is prescribed safer supply?
Prescribed safer supply follows evidence-based harm reduction models where doctors and nurse practitioners prescribe regulated opioids, such as oral hydromorphone (Dilaudid®) and long-acting morphine (Kadian® or M-Eslon®) or methadone, to replace dangerous street drugs.
What are the goals of prescribed safer supply?
The goals are to reduce overdose risk from dangerous street drugs, minimize harms related to injection drug use (HIV, Hepatitis, chronic wound infections), and improve client health. It helps people stay well, stabilize, and work towards their own goals without forcing them to reduce or quit drug use.
Who gets prescribed safer supply?
Safer supply is exclusively for adults diagnosed with opioid use disorder who use street drugs and face a high risk of overdose or other harms related to injection drug use. It is not for opioid-naive individuals but rather a harm reduction approach for adults dependent on the unregulated drug supply. Those prescribed safer supply have typically tried other treatments like OAT (Opioid Agonist Therapy) without success.
What safer supply medications are prescribed? How do they get them? Are they free?
Clients receive both short-acting and long-acting opioids, often covered by drug benefits or paid for directly. Most commonly, clients are prescribed short-acting hydromorphone (Dilaudid®), dispensed daily. They typically pick up a one-day supply from the pharmacy to use throughout the day and night, allowing flexibility for work, school, or hobbies. Some may consume all medication at the pharmacy for safety reasons or due to health concerns. Additionally, clients often receive slow-release oral morphine (Kadian® or M-Eslon®) or methadone, administered under pharmacist supervision each day to manage pain and prevent withdrawal.
How does Dilaudid® (hydromorphone) compare to fentanyl from the unregulated street supply? Is it truly “safe”?
While no opioids are entirely safe and all carry risks of overdose and dependency, Dilaudid® is considered safer than street opioids due to its known strength and composition. Dilaudid® provides similar pain relief and euphoria to heroin and fentanyl. The daily dosage of Dilaudid® varies among clients, typically capped at a maximum of 30 tablets per day, depending on the local unregulated drug supply.
What about diversion?
Diversion refers to sharing or selling medications, but there’s no evidence that prescribed hydromorphone (Dilaudid®) contributes to drug-related deaths or encourages opioid use (British Columbia Coroner’s Office, 2023; Public Health Ontario, 2023). Prescribed safer supply programs acknowledge diversion but have not found evidence of harm to communities. Providers prioritize community safety and will adjust strategies if needed based on research findings.
Why does diversion happen?
Diversion occurs with various medications, not just prescribed safer supply ones, including pain medications, antibiotics, ADHD medications, and others. It often involves sharing between friends and family, driven by care and concern, such as helping someone in withdrawal or preventing them from using street drugs. Providing broader access to safer supply could reduce the need for sharing. Additionally, diversion may stem from economic hardship or substance use needs, suggesting that addressing basic needs and ensuring appropriate medication access could mitigate diversion.
Is there evidence that diversion is creating harm in communities?
According to the BC Coroner’s Office, there’s no evidence that prescribed hydromorphone causes overdose deaths or that youth are using prescribed safer supply medications. Moreover, there’s no indication that prescribed safer supply medications prompt people to start or resume opioid use. Conversely, overwhelming evidence highlights the lethal dangers of the unregulated street supply. [Source: National Safer Supply Community of Practice, 2023]
Numbers Speak
PAO – Reducing Risk, Empowering Health.
35%
Reduction in Overdose Deaths
19%
Decrease in HIV Transmission
$6M+
Annual Healthcare Savings
30%
Increase in Access to Treatment
PAO OPEN HOUSE
Hours of Operation:
Open: Monday to Friday: 09:30 – 17:00
Closed: Saturday and Sunday
(On-call availability for weekends and after 5pm on weekdays)
Contact Information:
HUSS Program
70 James Street South
Hamilton, Ontario, L8R 2K4
Fax (Referrals): 905-522-3433
Email: huss@hucchc.com