For people at high-risk of overdose enrolled in a safer opioid supply (SOS) program, there was a rapid decrease in emergency department visits and hospitalizations soon after initiation, according to a new study led by Unity Health Toronto researchers.

The study, published in CMAJ (Canadian Medical Association Journal), also found there were no opioid-related deaths and lower rates of infection in participants of the safer opioid supply program.

There were more than 29,000 opioid-related deaths in Canada from 2016 through 2021. High and unpredictable levels of fentanyl in the unregulated drug supply are the main cause of overdose. SOS programs have been scaled-up in several provinces including Ontario – using funding from Health Canada – as an intervention that may help to address the drug poisoning overdose crisis in Canada.

Safer opioid supply programs are a harm reduction measure providing prescription opioids to people at high risk of overdose because they are using fentanyl from the unregulated drug supply. The opioids prescribed are generally daily-dispensed immediate-release hydromorphone, provided as take-home doses. Some programs also provide wrap-around health and social supports, such as comprehensive primary care, treatment for medical conditions and access to social support workers. However, there is a lack of published evidence on the real-world impacts of SOS programs.

Dr. Tara Gomes

“The positive impacts were seen very quickly after entering the safer supply program,” said lead author Dr. Tara Gomes, a Scientist at the Li Ka Shing Knowledge Institute of St. Michael’s Hospital and ICES, and a Principal Investigator of the ODPRN. “We did not see similar changes in a matched group of people with opioid use disorder not enrolled in the program, suggesting that the improvements seen in safer supply clients were because of participation in the program, and not influenced by outside factors.”

To understand the impact of these programs, researchers looked at health outcomes, health services utilization and health care costs associated with Canada’s first formal SOS program, which started at the London InterCommunity Health Centre (LIHC) in London, Ontario in 2016. They looked at data on 82 clients in the program to see how their health outcomes changed after starting the program compared to unexposed local residents diagnosed with an opioid use disorder. For program participants, there was a rapid decrease in emergency department visits, hospitalizations (including hospitalizations for certain bacterial infections associated with injection drug use) and healthcare costs (excluding primary-care and medication-related costs).

The average age for people in the study was 41 years of age and 40 per cent were male. High rates of HIV (34 per cent), Hepatitis C (69.5 per cent) and infectious complications (28 per cent) in the year before enrollment suggests the program is reaching a group of people who had been experiencing serious medical complications from drug use.

Dr. Gillian Kolla

“There have been concerns raised about SOS programs, and both the improvements in health services usage and lack of negative outcomes detected among clients provides important reassurance about the safety of these programs,” said Dr. Gillian Kolla, Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC. “It is important to note that the London program also offers comprehensive primary care and social supports to safer supply clients, so it will be important for future research to examine the impact of different program elements on client outcomes.”

The authors note that more research is needed to understand the benefits and potential risks of SOS programs, but are reassured by the findings reported in this study.

“Our findings provide preliminary evidence that SOS programs can play an important role in the expansion of treatment and harm reduction options available to people who use drugs at high risk of drug poisoning,” the authors conclude.

The study was conducted by researchers from Unity Health Toronto, ICES, Leslie Dan Faculty of Pharmacy and Institute for Health Policy Management and Evaluation, University of Toronto; MAP Centre for Urban Health Solutions St. Michael’s Hospital, Toronto, Ontario; Canadian Institute for Substance Use Research. University of Victoria, Victoria, BC; London InterCommunity Health Centre (Sereda), London, Ontario.

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