Canadian Safer Opioid Supply Program Improves Outcomes

The Safer Opioid Supply (SOS) program near Toronto, Canada, appears to be a safe and effective harm reduction initiative, according to new data.

Analysis shows that the program is associated with a reduction in emergency department visits, hospitalizations and overall healthcare costs. Additionally, there were no opioid-related deaths among participants who were at high risk of overdose.

“Immediately after the start of the SOS programs, not only did hospital commitments decrease, but the risk of overdose did not change, and there were no opioid-related deaths at the 1-year follow-up,” study author Tara Gomes, PhD, an assistant professor of health policy, management and assessment at the University of Toronto and a researcher at the Li Ka Shing Knowledge Institute at St. Michael’s Hospital in Toronto Medscape Medical News.

Gomes is the senior principal investigator for the Ontario Drug Policy Research Network, a collaboration between researchers and drug policy makers in the province.

“These changes were not observed in a group of similar individuals living in the same city – i.e. exposed to the same illicit supply of drugs – but not part of this programme, which helps underscore that these changes are specific to SOS participation. ” She said.

The study was published in Journal of the Canadian Medical Association on 09/19

Denied hospital admissions

According to investigators, more than 29,000 opioid toxicity-related deaths occurred in Canada between 2016 and 2021, often as a result of high levels of fentanyl in the drug supply. In response, SOS programs have been launched in several provinces, including the first formal SOS program at the London InterCommunity Health Center in Ontario. As part of the program, clients are prescribed pharmaceutical opioids as an alternative to fentanyl adulterated drug supplies and receive health and social support.

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Gomes and colleagues performed a discontinuous time-series analysis of residents in London, Ontario who received a diagnosis of opioid use disorder and had a medical encounter related to the diagnosis between January 2016 and March 2019. They followed 82 participants who joined the SOS program and a comparison group of 303 people who were matched for demographic and clinical characteristics but did not participate in the program.

The research team focused on the number of emergency department visits, hospital admissions, infection rates and healthcare costs of the population. They used autoregressive integrated moving average models to assess the impact of starting the SOS program and to compare population outcome rates in the year before and after entering the program.

For participants who participated in the program, the emergency room visit rate decreased by approximately 14 visits per 100 people. In addition, hospital admissions decreased by about five admissions per 100 people. Healthcare costs not related to primary care or outpatient medications decreased by about $922 per person. The rate of hospitalizations for infections remained about the same; investigators observed a decrease of about 1.6 infections per 100 people.

In the year following enrollment in the program, emergency room admissions, hospital admissions, infection-related admissions and overall health care costs among SOS clients decreased significantly compared to the previous year.

Conversely, for the 303 people who did not participate in the program, there were no significant changes in the measured outcomes.

increased drug costs

Gomes and colleagues noted that the results provide preliminary evidence that SOS programs can play a role in the harm reduction options available to those at high risk of drug intoxication and overdose. At the same time, many questions remain unanswered.

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For example, although total health care costs decreased among participants in the program, drug-related costs increased. Approximately 34% of participants had HIV, 69.5% had hepatitis C virus infection, and 28% had infectious complications in the year prior to the start of the program. This finding may indicate that the participants had serious medical complications from their drug use and were able to access health services.

“We interpret this as a positive result, since HIV and hepatitis C are very common among SOS Children’s Village clients. HIV and hepatitis C treatments are life-saving but expensive,” Gomes said. “Hence, these higher drug costs likely reflect increased access to treatments for these infections, which can significantly improve people’s health and quality of life, but also save the healthcare system money in the long run.”

Gomes and colleagues are now beginning to evaluate other SOS programs across Ontario. They hope to better understand the different approaches available and determine which models can best support people who are at high risk from drug use.

A limited solution?

Commenting on the study for Medscape, Andrew Ivsins, PhD, a postdoctoral fellow in social medicine at the University of British Columbia at Vancouver and a research scientist at the British Columbia Center on Substance Abuse, said, “This is an important study and one of the first to show how safe care can help by creating connections to the healthcare system that didn’t exist before.”

Ivsins, who was not involved in this study, researched safe care programs across Vancouver. He and his colleagues found that participants in these programs reduced their use of illegal, street-bought drugs, leading to improved health and well-being.

“Supply security is basically, at the most basic level, a response to the highly toxic drug supply and runaway poisoning crisis in North America,” he said. “It’s a contentious issue, but it makes so much sense that if what kills people are highly toxic drugs, then we need to find a way to offer an option that doesn’t kill them.”

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“Until now, safer care has been used primarily to reduce harms, including mortality and morbidity, in people who use illicit opioids. But if we really want to reduce the risk associated with high levels of contamination in the unregulated drug supply, safer supply programs need to “expand to all potentially illicitly sold substances,” said Marie-Eve Goyer, MD, assistant professor of family medicine at the University of Montreal Medscape Medical News.

Goyer, who was not involved in this study, conducted research on substance replacement therapy in Quebec. She noted that many provinces are now reporting new potent designer benzodiazepines that use or contaminate fentanyl, requiring a broader approach to address the drug overdose crisis.

“Let’s recognize that prescribing safer care is a very medical (and limited) solution to an epidemic composed of stigma, criminalization, and repressive public policies,” she said. “Without real changes in the law, we will continue to see our people dying every day.”

The study was funded by grants from the Ontario Department of Health and the Canadian Institutes of Health Research. Gomes has received grants to support research by both groups, and other authors have received support or fees associated with the London InterCommunity Health Centre. Ivsins and Goyer have disclosed no relevant financial relationships.

CMAJ. Published September 19, 2022. Full text

Carolyn Crist is a health and medical journalist, covering the latest studies for Medscape, MDedge and WebMD.

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