Characterizing safer supply prescribing of immediate release hydromorphone for individuals with opioid use disorder across Ontario, Canada

Clinical outcomes and health care costs among people entering a safer opioid supply program in Ontario

“…often paired with long-acting opioid medications (primarily slow-release oral morphine and, less frequently, methadone) as well as additional interventions to promote engagement with care and management of co-existing conditions. 15 This model was followed for Canada's first formal SOS program, which began at the London InterCommunity Health Centre (LIHC) in 2016. In addition to providing pharmaceutical opioids, the LIHC program offers comprehensive health and social services, including primary care and management of infection with HIV and hepatitis C virus (HCV), alongside access to an interdisciplinary team that provides harm-reduction equipment, counselling, housing support and social services (details about the LIHC SOS program can be found in Appendix 1, eTable 1, available at www.cmaj.ca/lookup/doi/10.1503/ cmaj.220892/tab-related-content).…”

“…In addition to providing pharmaceutical opioids, the LIHC program offers comprehensive health and social services, including primary care and management of infection with HIV and hepatitis C virus (HCV), alongside access to an interdisciplinary team that provides harm-reduction equipment, counselling, housing support and social services (details about the LIHC SOS program can be found in Appendix 1, eTable 1, available at www.cmaj.ca/lookup/doi/10.1503/ cmaj.220892/tab-related-content). 16 Recent research examining pharmacy claims data found that safer supply prescribing has gradually increased in Ontario during this period, with 534 new initiations occurring between January 2016 and March 2020, 15 and a peak in initiations in the second half of 2019, which corresponds to the publication of a safer supply guiding document for prescribers. 12 More recently, practice and policy changes have supported the piloting and delivery of SOS programs across Canada.…”

“…In Ontario, SOS is currently reaching a limited number of people, 15 and although the province of British Columbia has released a policy for the expansion of "prescribed safer supply," 31 other provinces have been more reticent. Additional research is needed to deepen our understanding of the benefits and potential risks of different models of SOS, but our findings provide preliminary evidence that SOS programs can play an important role in the expansion of treatment and harm reduction options available to people who use drugs at high risk of drug poisoning.…”

Evaluation of an emergency safe supply drugs and managed alcohol program in COVID-19 isolation hotel shelters for people experiencing homelessness

“…Prior research in the hospital setting has shown that offering more medication options (specifically SROM) in addition to methadone and buprenorphine may increase treatment uptake ( Brothers et al, 2022 ), but we are not aware of any published data on the role of safe supply medications for hospitalized patients. Offering safe supply medications in addition to OAT medications has been a common medical model of providing safe supply in outpatient settings in Canada ( Hales et al, 2020 , Glegg et al, Submitted ); most safe supply medications were co-prescribed with OAT in a recent evaluation from Ontario ( Young et al, 2022 ).…”

“…Provisional prescribing of safe supply medications and managed alcohol to facilitate COVID-19-related physical distancing or isolation has also been termed “risk mitigation” or “pandemic prescribing” ( Bonn et al, 2020 , et al, 2020 , Glegg et al, Submitted , Tyndall, 2020 , Chang et al, 2020 ). The uptake of safe supply prescribing on a population level is under evaluation ( Glegg et al, Submitted , Nosyk et al, 2021 , Young et al, 2022 , McNeil et al, 2022 ).…”