Safer opioid supply program results in lower hospitalizations and ER visits: study

TORONTO — Opioid safety programs can significantly reduce the number of emergency room visits and hospitalizations for people at high risk of overdose, new research from Ontario has found.

TORONTO — Opioid safety programs can significantly reduce the number of emergency room visits and hospitalizations for people at high risk of overdose, new research from Ontario has found.

A study published Monday in the Canadian Medical Association Journal examined people who used a safer opioid supply program in London, Ont., for just over three years, and found that emergency department visits and Hospital admissions had declined one year after participants entered the program.

The study also found no increased risk of infections or overdoses and lower health care costs not related to primary care or outpatient medication after one year.

Lead author Tara Gomes, an epidemiologist at Unity Health in Toronto, says the study indicates London’s safer opioid supply program is “very safe” and a model that should be applied more widely to expand options harm reduction for people at high risk of overdose.

“We found no opioid-related deaths among people who were on this program within one year of entering the program,” Gomes said.

“I think that really provides useful evidence that these programs can not only benefit people, in terms of improving their overall health, but they can also be very safe for them.”

Safer opioid supply programs prescribe pharmaceutical opioids to people at high risk of overdose, as an alternative to an unregulated drug supply.

The researchers behind the study used data from ICES, a Toronto-based nonprofit organization that captures, saves, and anonymizes health records from every doctor or hospital visit in Ontario.

They worked with the London InterCommunity Health Centre, which launched a safer opioid supply program in 2016, using enrollment information between January 2016 and March 2019 to assess the program’s effect on system costs. health.

The researchers focused on the five years before customers entered the safer supply program and the year after, using a method called time series analysis to see what customers’ lifestyles would have been like. they had not been registered.

Gomes said this approach allowed researchers to assess the impact of the London program and how access to a safer drug supply changed expected outcomes for clients.

She said the study had two main limitations, the first being that London Health Center combines a safer drug supply site with other health and social services for clients. She says this suggests the program was particularly effective when combined with other types of services.

“What we need to know is that as we look at other safer supply programs that are being rolled out, what kinds of services are they providing and do they also have these global services that can also be beneficial? And can we also evaluate different models that are out there to see what maybe works better?” she says.

Gomes added that another limitation of the study was the lack of information about diversion, saying some people feared people would share drugs from a safer supply with others rather than use them. themselves.

“We can’t capture that in the data,” Gomes said. “But what we can say is that…most of the time this sharing of their supply is because (customers) are trying to help their friends, family or community members get access to a known substance that they’re accessing through safer supply. And so it’s really more indicative of the fact that there just aren’t enough safer supply programs out there to meet people’s needs .

The study found that more than 29,000 people died in Canada from opioid-related toxicity between January 2016 and December 2021.

According to the federal government, there was a 96% increase in deaths from apparent opioid toxicity in the first year of the COVID-19 pandemic compared to the previous year in 2019.

It says the majority of opioid overdose deaths have occurred in British Columbia, Alberta and Ontario, adding that increases have also been seen in other regions and the number of deaths has remained high since the first pandemic year.

“I think many jurisdictions in Canada are dealing with this runaway drug poisoning crisis that will take a lot out of this study,” said Thomas Kerr, research director at the BC Center on Substance Use, who was not part of the study. study.

“I believe it will inform practice and study across the country.”

Kerr said he viewed the research as “historical study.”

“There has been much discussion and debate about the potential merits and harms of safe supply programs, and this study provides some of the first rigorous data on long-term outcomes ever produced,” he said. .

“Unfortunately, the safe supply conversation has been grossly clouded by misinformation and, in some cases, politicization of science. So it’s really important that we have access to data like this, demonstrating that the program is not only safe, but produces positive effects,” he said.

Kerr said the research indicates that society must continue to think outside the box to find solutions to the drug crisis.

“We need to continue to expand access to these programs and continue to evaluate them very rigorously,” he said.

“There are still other security of supply issues that need to be addressed, but what this study seems to show is that for people enrolled in the program, it is safe and it produces a series positive benefits.”

This report from The Canadian Press was first published on September 19, 2022.

Jessica Smith, The Canadian Press

Ryan H. Bowman