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Prescribing safe supply: ethical considerations for clinicians
  1. Katherine Duthie1,
  2. Eric Mathison1,2,
  3. Helgi Eyford3,
  4. S Monty Ghosh4
  1. 1 John Dossetor Health Ethics Centre, University of Alberta, Edmonton, Alberta, Canada
  2. 2 Department of Philosophy, University of Toronto Scarborough, Toronto, Ontario, Canada
  3. 3 Clinical Ethics Service, Alberta Health Services, Edmonton, Alberta, Canada
  4. 4 Addictions Services, Alberta Health Services, Calgary, Alberta, Canada
  1. Correspondence to Dr Katherine Duthie, John Dossetor Health Ethics Centre, University of Alberta, Edmonton, T6G 2T4, AB, Canada; kmduthie{at}


The COVID-19 pandemic has exacerbated the drug poisoning epidemic in a number of ways: individuals use alone more often, there is decreased access to harm reduction services and there has been an increase in the toxicity of the unregulated drug supply. In response to the crisis, clinicians, policy makers and people who use drugs have been seeking ways to prevent the worst harms of unregulated opioid use. One prominent idea is safe supply. One form of safe supply enlists clinicians to prescribe opioids so that people have access to drugs of known composition and strength. In this paper, we assess the ethical case for clinicians providing this service. As we describe, there is much that is unknown about safe supply. However, given the seriousness of the overdose death epidemic and the current limited evidence for safe supply’s efficacy, we argue that it is ethically permissible for clinicians to begin prescribing opioids for some select patients.

  • ethics
  • substance-related disorders

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  • Contributors SMG proposed the paper topic and approached the other authors to develop and write the paper. EM, HE, SMG and KD each wrote separate sections of the paper and all participated in reviewing and revising the paper over several iterations. KD and EM completed the majority of the revisions in light of reviewer comments, with additional help from SMG. All authors approved the final revised version. KD is the guarantor for this paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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