I think it's unfortunate that there's been this binary discussion of safe supply or no safe supply. I don't think that's what the focus should be. I think the focus should be on ensuring that safe supply is actually safe for individual patients and the public.
This idea of prescribing large numbers of take-home tablets is actually harming people. It's leading to unnecessary and deadly bacterial infections. It's leading to diversion, which increases the use of hydromorphone and then ultimately fentanyl among youth and among people on OAT, and other problems. This can be practically and feasibly made safer by having hydromorphone tablets. The issue is not hydromorphone versus methadone. The issue is take-home versus not take-home. If you allow take-home, and people are clearly involved in the drug trade, you'll have diversion. It will harm people. Have supervised hydromorphone, supervised methadone and supervised injection opioid agonist therapy. That's what's needed.
In terms of rural communities, it really is a very bad situation, at least in Ontario. Some of the OAT providers are these large corporate chains that do not provide high-quality care. Even physicians who want to provide good care have limited access to case management and mental health resources. Some rural communities have no OAT at all. Some pharmacies neglect or refuse to dispense OAT. That is a problem. I think it's very unfortunate that SUAP has put all their resources into safer supply, yes, and other initiatives, while downplaying opioid agonist treatment. I think that needs to be changed. There needs to be a balanced approach.