Motivations for and perspectives of medication diversion among clients of a safer opioid supply program in Toronto, Canada

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BackgroundSafer opioid supply programs in Canada have come under intense scrutiny related to the perceived risk of diversion of safer opioid supply medications. We sought to explore the experiences and perspectives of safer opioid supply medication diversion with clients of a safer opioid supply program in Toronto, Canada. MethodsFrom December 2022 to August 2023, we conducted in-depth, semi-structured interviews with 25 adult clients of a safer opioid supply program in Toronto, Canada. We analyzed the data using deductive and inductive approaches via thematic analysis. ResultsOur analysis identified five themes regarding clients’ perceptions and experiences with safer opioid supply diversion: (i) Compassionate sharing with others to address withdrawal symptoms; (ii) Selling or sharing due to unmet medication or survival needs of program clients; (iii) High demand for safer alternatives to those that are available in unregulated drug markets; (iv) Price of safer opioid supply medications in the unregulated drug markets as a diversion deterrent; and (v) Coerced diversion through harassment or violence. ConclusionsThese findings document experiences of medication diversion and the multifaceted and complex interplay of various individual and contextual factors that motivate safer opioid supply clients to engage in it. Future policy and safer opioid supply model design should address root causes of diversion, particularly barriers to service access and the diverse medication needs of clients.