The danger of the opioid crisis in Canada is undeniable.
Over 20,000 Canadians died due to opioid toxicity over the five-year period from 2016 to 2021. In British Columbia, the centre of the nation’s opioid crisis, deaths due to opioid toxicity were far higher than deaths due to COVID-19 during the pandemic — a startling reminder of the scale of the crisis.
As a large factor behind the deaths has been the presence of toxic impurities such as fentanyl in the drug supply, users and activists have called for government programs ensuring safer drug supply in the form of prescribed opioid and stimulant alternatives. A recent study published in the Canadian Medical Association Journal by researchers from Unity Health Toronto suggests promising results for these safer supply programs.
What are safer opioid supply programs?
As the authors of the study explain, safer opioid supply (SOS) programs allow individuals who are at a high risk of overdose to receive prescriptions for pharmaceutical opioid alternatives. These are intended to replace the supply of illicit drugs, which are often contaminated with fentanyl and its analogues. This is crucial to reducing overdoses, as fentanyl is responsible for the vast majority of deaths related to opioid use.
Given the relative lack of research surrounding the efficacy of these novel programs, the authors decided to compare the health outcomes of those who used SOS programs compared to similar opioid users who did not use these programs.
To better understand this, they monitored the London InterCommunity Health Centre (LIHC) in London, Ontario — which launched the first SOS program of its kind in Canada. In addition to opioid alternatives, such as daily doses of hydromorphone and longer-acting oral morphine, the LIHC also offers its clients other services such as assistance with HIV and hepatitis C management, housing guidance, counselling, and other social services.
Who did the researchers monitor?
To understand the differences between those who used the SOS program and those who did not, the researchers matched 82 individuals who attended — or were “exposed” to — the LIHC program with 303 individuals who did not.
However, these “unexposed” individuals were similar to the exposed ones on many other factors such as age, sex, geographic area, income, and hospital admissions in the period prior to SOS treatment. This ensured that these other factors were not responsible for any differences in health outcomes between the individuals.
What did the researchers measure?
To fully understand the complex factors that relate to substance use and harm-reduction programs, the researchers examined a variety of outcomes among their sample population.
This included hospital admissions, health care costs, mental health ER visits, opioid-related ER visits, substance-use related ER visits, and opioid-related deaths. They used a suite of statistical analyses to measure the differences in these outcomes between individuals who entered the LIHC’s SOS program between January 2016 and March 2019, and those who did not.
What did the researchers find?
Those who underwent the SOS program experienced decreased ER visits, decreased inpatient hospital admissions, and lower healthcare costs not involving primary care or outpatient medications following their entry into the program. However, rates of admission for infection were not affected by program entry.
A year after entry into the SOS program, the rates of ER visits, hospital admissions, admissions for infections, and total health care costs decreased significantly among clients when compared to the prior year. In contrast, “unexposed” individuals did not demonstrate any significant changes in any of the healthcare outcomes.
Though cautious, the researchers interpreted their results optimistically, claiming that “SOS programs can play an important role in the expansion of treatment and harm-reduction options available to assist people who use drugs and who are at high risk of drug poisoning.”
Given the severity of the crisis, and the complex factors affecting opioid use, it is clear that further government action — such as the implementation of SOS programs — is needed to save lives. However, there are promising signs that the tide may be turning on this issue. Announcements of increased funding for SOS pilot programs similar to the one mentioned in the study are a promising sign that a different approach may be taken to address the crisis of substance abuse.
