ABSTRACT
The increasingly unpredictable and toxic unregulated drug supply puts people who use drugs at high risk of overdose and death. In April 2022, Insite—North America’s first sanctioned supervised consumption site—started a prescribed powdered fentanyl safer supply program available to patients for on-site consumption. This novel pharmaceutical product, created in partnership with a community compounding pharmacy, can be smoked or injected; is free of dangerous contaminants (e.g., xylazine and non-prescribed benzodiazepines); and has a predictable concentration. This case describes a man in his 50s with no fixed address and severe opioid use disorder and stimulant use disorder prescribed powdered fentanyl at Insite, which led to reduced use of unregulated drugs, increased supervised consumption site engagement and increased retention on oral opioid agonist therapy. Expansion of supervised consumption services to incorporate the provision of prescribed alternatives to the drug supply for on-site supervised consumption holds promise and should be evaluated.