A fentanyl user displays a 'safe supply' of opioid alternatives in Vancouver on April 6, 2020.JESSE WINTER/Reuters
A new study of the earliest formal program to offer prescription opioids to drug users suggests their health improved under the medication, one of the study’s authors says. But some experts warn it’s too early to draw conclusions about the efficacy of safe supply programs.
Researcher Tara Gomes of Toronto’s Unity Health network said the study she helped conduct showed that emergency department visits, hospitalizations and some health care costs declined among those who took the prescription opioids. She said it was the first study she knew of to study the long-term effects of offering a safe supply of opioids to drug users, a system that is being rolled out in several places across the country in an attempt to reduce the toll of the opioids crisis, which claimed 29,000 lives from 2016 through 2021.
Though safe supply might not be the solution for everyone, “this really shows that this program can be beneficial for people at a high risk of overdose,” said Ms. Gomes, speaking in advance of the study’s Monday release.
She cautioned that “obviously more work needs to be done” and “we don’t ever want to make broad, sweeping statements based on one study.”
Critics of safe supply also raised a warning flag, saying the system is in its infancy and that it’s far too early to say whether it will really reduce overdoses and other harms.
Published in the Canadian Medical Association Journal, the study by the Ontario Drug Policy Research Network focused on a program that began in 2016 at the London InterCommunity Health Centre in London, Ont. Poring over six years of data, researchers studied health indicators for 82 participants and compared them to data from other local drug users.
“The researchers saw a rapid decrease in emergency department visits, hospitalizations [including hospitalizations for certain bacterial infections associated with injection drug use] and health care costs [excluding costs related to primary care and medication],” a news release on the study said.
The doctor behind the London program, Andrea Sereda, says she began prescribing doses of hydromorphone, an opioid painkiller, to patients when the powerful drug fentanyl flooded the illicit market for drugs and fatal overdoses soared.
She said she started on “a wish and prayer,” hoping it might make a difference. Now she has 300 patients on safe supply, and similar programs have opened from Vancouver to Ottawa.
Dr. Sereda said the Unity Health study confirms what she sees in her practice. She said 94 per cent of participants stay in the program, a much higher share than stay on methadone or buprenorphine, other substitute drugs prescribed to drug users.
She said participants tend to have fewer brushes with the law and fewer visits to emergency. They no longer need to bargain with drug sellers or do sex work and petty crimes to pay for their drugs. “Their day-to-day life is remarkably better,” she said.
She said the improvement has been especially marked among older drug users, some of whom have been using for 30 or 40 years. “Within weeks we see their lives stabilize medically and socially. That has been so profound,” she said.
Participants who have HIV have also improved, she said. They are given HIV drugs along with their safe supply. “They take their HIV medications every day now.”
But safe supply still has its doubters. Simon Fraser University health sciences professor and clinical psychologist Julian Somers of Vancouver argues that giving homes to the homeless and treatment to the mentally ill makes more sense than prescribing them opioids. “Rather than expanding effective services that promote agency and human dignity, our leaders contemplate vacuous practices like giving homeless people more drugs,” he wrote in the Vancouver Sun last year.
Asked about the safe supply report, he said in an e-mail that Canada instead needs “evidence-based interventions” that “effectively address the needs of people who experience homelessness, mental illness, addictions, unemployment and chronic illnesses.”
Toronto author and doctor Vincent Lam said that while the researchers behind the report are well-respected and that it was great to see more analysis of such an important issue, the study did not prove the case for what he called public supply of addictive drugs.
In a telephone interview, he said the improvements seen in the studied group might have come from them getting wraparound health care and social supports from the London clinic, not from the prescribed drugs. Attributing the improvement to the drugs, he said, was like painting an old car yellow and saying it was safer because of the paint, though you had also added a seatbelt and airbag.
He is also concerned that participants in such programs will sell some of their prescribed drugs, adding to the street supply of opioids. In the addiction clinic he runs, some patients are coming in with a recent drug problem that stems from using safe supply drugs that they bought on the street, he said.
He said proven drugs such as methadone, buprenorphine and others have been shown to help those suffering from addiction and it’s not clear that safe supply is better, despite preliminary studies like the one by Unity Health.
“The greatest concern I have is that we might be offering something which risks being less helpful, or is not better, when we have established treatments that have a strong body of evidence to support them,” he said.
Proponents of safe supply say it’s a way to curb the growing number of Canadians dying each year to a street drug supply saturated with dangerous substances such as fentanyl. Safe supply programs offer pharmaceutical alternatives and studies show they can prevent overdoses and other crime, while critics worry that recipients may sell their prescribed drugs to buy other substances.
The Globe and Mail