British Columbia’s Safer Opioid Supply Policy and Opioid Outcomes

Abstract

ImportanceIn March 2020, British Columbia, Canada, became the first jurisdiction globally to launch a large-scale provincewide safer supply policy. The policy allowed individuals with opioid use disorder at high risk of overdose or poisoning to receive pharmaceutical-grade opioids prescribed by a physician or nurse practitioner, but to date, opioid-related outcomes after policy implementation have not been explored.ObjectiveTo investigate the association of British Columbia’s Safer Opioid Supply policy with opioid prescribing and opioid-related health outcomes.Design, Setting, and ParticipantsThis cohort study used quarterly province-level data from quarter 1 of 2016 (January 1, 2016) to quarter 1 of 2022 (March 31, 2022), from British Columbia, where the Safer Opioid Supply policy was implemented, and Manitoba and Saskatchewan, where the policy was not implemented (comparison provinces).ExposureSafer Opioid Supply policy implemented in British Columbia in March 2020.Main Outcomes and MeasuresThe main outcomes were rates of prescriptions, claimants, and prescribers of opioids targeted by the Safer Opioid Supply policy (hydromorphone, morphine, oxycodone, and fentanyl); opioid-related poisoning hospitalizations; and deaths from apparent opioid toxicity. Difference-in-differences analysis was used to compare changes in outcomes before and after policy implementation in British Columbia with those in the comparison provinces.ResultsThe Safer Opioid Supply policy was associated with statistically significant increases in rates of opioid prescriptions (2619.6 per 100 000 population; 95% CI, 1322.1-3917.0 per 100 000 population; P < .001) and claimants (176.4 per 100 000 population; 95% CI, 33.5-319.4 per 100 000 population; P = .02). There was no significant change in prescribers (15.7 per 100 000 population; 95% CI, −0.2 to 31.6 per 100 000 population; P = .053). However, the opioid-related poisoning hospitalization rate increased by 3.2 per 100 000 population (95% CI, 0.9-5.6 per 100 000 population; P = .01) after policy implementation. There were no statistically significant changes in deaths from apparent opioid toxicity (1.6 per 100 000 population; 95% CI, −1.3 to 4.5 per 100 000 population; P = .26).Conclusions and RelevanceTwo years after its launch, the Safer Opioid Supply policy in British Columbia was associated with higher rates of safer supply opioid prescribing but also with a significant increase in opioid-related poisoning hospitalizations. These findings will help inform ongoing debates about this policy not only in British Columbia but also in other jurisdictions that are contemplating it.

Ending the overdose epidemic by ending the war on drug users: Can this work?

“…Some diversions, though, might lead to new addictions and other harms. 40 Elsewhere in Canada, rapid access treatment programs have shown efficacy 41 but these services are offered to too few people. 42 Finally, concern has been expressed that policies are being introduced without adequate consideration…”

Examining Safer Opioid Supply Policies

“…To the Editor We felt compelled to raise concerns regarding the design and conclusions of the recent cohort study by Nguyen et al in JAMA Internal Medicine because Slaunwhite et al authored another recent population-based cohort study in a separate journal using individual-level data that reached different conclusions. Although the ecological design used by Nguyen et al can be useful, this design is prone to well-known biases regarding attribution. In this case, misclassification in exposure (fentanyl and oxycodone, 2 of 4 drug classes that were not included in the Risk Mitigation Guidance) and outcome (hospitalizations only, excluding emergency department visits and other health care contacts for people who overdose) exacerbate these biases.…”

“…To the Editor We felt compelled to raise concerns regarding the design and conclusions of the recent cohort study by Nguyen et al in JAMA Internal Medicine because Slaunwhite et al authored another recent population-based cohort study in a separate journal using individual-level data that reached different conclusions. Although the ecological design used by Nguyen et al can be useful, this design is prone to well-known biases regarding attribution.…”

“…However, the fundamental challenges to difference-in-differences studies include discerning policy effects from other contemporaneous changes and ensuring underlying trends associated with the policy and outcome are parallel in exposed and unexposed populations. We believe the study is flawed on both counts. First, many of the 49 supervised consumption and overdose prevention sites in British Columbia, Canada, closed or restricted hours of operation at the onset of the COVID-19 pandemic; as a result, monthly visitation counts plummeted from 63 129 in January 2020 to 26 888 in April 2020 .…”

New Choking Epidemic Trends in Psychoactive Drugs: The Zombifying Combination of Fentanyl and Xylazine Cause Overdoses and Little Hope in Rehabilitation

“…countries and even a topic of debate in political campaign trail [10][11][12]. Indeed, the fentanyl presence in both prescription medications and illicit street drugs has complicated efforts to control the crisis, necessitating comprehensive strategies that address both the medical and illicit aspects of opioid use.…”