TUESDAY, Sept. 20, 2022 (HealthDay News) — As the death rate from opioid overdose continues to rise, a Canadian program is pointing to one way to save lives: providing “safer” opioids to people at risk of overdose.
That’s the conclusion of a study evaluating Canada’s first official Safer Opioid Supply, or SOS, program. Such programs aim to prevent overdoses by giving vulnerable people an alternative to the increasingly dangerous street supply of opioids.
In this case, the London, Ontario program provided clients with a daily dose of prescription opioid tablets, as well as basic health care, counseling and social services.
The researchers found that the result was a rapid decrease in emergency department trips and hospitalizations among the 82 clients studied. And for six years, there was no overdose of death.
“I think this is a landmark study,” said Thomas Kerr, director of research at the British Columbia Center on Substance Use, in Vancouver, Canada.
Kerr, who was not involved in the study, admitted that SOS programs are controversial and have their critics. Concerns included the potential for opium pills to be sold, or people to crush and inject the pills, which poses risks of overdose or infection.
But Kerr said criticism about providing safer supplies has been leveled in the absence of data.
“The misinformation clouded the entire conversation,” he said. “When we talk about matters of life and death, we cannot rely on people’s opinions.”
Kerr said he hopes the new findings will “disguise some misinformation”.
The study was published on September 19 in KMG (Canadian Medical Association Journal). It comes amid a worsening opioid epidemic.
In the United States, deaths from opioid overdose have been on the rise for years, and the situation has worsened after the pandemic. In 2020, nearly 92,000 Americans died from a drug overdose — largely including opioids, according to the U.S. Centers for Disease Control and Prevention.
Health officials say the crisis has been driven primarily by illegally made versions of the pain reliever fentanyl, a synthetic opioid 50 times more powerful than heroin. Illicit fentanyl is sold in various forms, including pills made to look like other prescription opioids. It is also commonly mixed with other illegal drugs, such as cocaine and heroin, to enhance its effectiveness. The result is that users often do not realize they are taking fentanyl.
Safer supply programs are based on the harm reduction principle – overdose, infections, and other consequences of opioid addiction can be prevented, without requiring drug abusers to abstain completely.
The new findings come from a program that began in 2016 at the London Inter Community Health Centre. It provides customers with Hydromorphone (Dilaudid) tablets, dispensed daily, as well as many other services – including primary health care, treatment of infections such as HIV and hepatitis C, counseling, housing assistance and other social services.
The researchers, led by Tara Gomez, of Unity Health Toronto, looked at data on all 94 clients who entered the program between 2016 and March 2019. They compared 82 of these people against 303 individuals diagnosed with opioid addiction who did not participate in the program. a program.
The study found, over a one-year period, that emergency department visits and hospitalizations decreased among program clients, while remaining unchanged in the comparison group. And while customers were paying for the drugs — which Ontario’s prescription drug plan covers — annual health care costs outside of primary care fell: from about $15,600, on average, to $7,300.
Again, there was no significant change in the comparison group.
Dr. Sandra Springer is an associate professor at Yale University School of Medicine in New Haven, Connecticut, and she helped formulate practice guidelines for the American Society of Addiction Medicine.
“This study is further evidence that programs that meet patients wherever they are and provide easy access to clinical care to treat opioid use disorder can save more lives and reduce health care costs,” said Springer, who was not involved in the research.
Opioid dependence can be treated by itself with medication-assisted therapy, which includes counseling and medications such as buprenorphine, methadone, and naltrexone.
“Although this SOS program did not make conventional opioid use disorder medications available to all participants, these medications were available to patients through the program,” Springer noted.
She said other research has shown that when drug users are offered “compassionate care”, they are more likely to accept “evidence-based treatment”.
It remains to be seen how widespread SOS software will be. In 2020, Health Canada announced its funding for several additional pilot programmes. And last year, New York City opened two overdose prevention sites — where people with opioid addiction can use drugs in a clean, supervised environment and connect with health care and social services.
These sites are the first publicly recognized overdose prevention centers in the United States.
In the face of the worsening opioid crisis, “the status quo response is not enough,” Kerr said.
“We have to try new methods, and evaluate them scientifically,” he said.
The US National Institute on Drug Abuse has more on opioid use disorder.
SOURCES: Thomas Kerr, PhD, director, research, British Columbia Center on Substance Use, Professor of Social Medicine, University of British Columbia, Vancouver, Canada; Sandra Springer, MD, associate professor, medicine, Yale University School of Medicine, New Haven, Connecticut; CMAJ, September 19, 2022, online