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By Amy Norton
Health Day Reporter

TUESDAY, September 20, 2022 (HealthDay News) — As opioid overdose deaths continue to rise, a Canadian program is pointing to a way to save lives: making “safer” opioids available to people at high risk of overdose.

That’s the finding of a study evaluating Canada’s first formal “safer opioid supply program,” or SOS program. Such programs aim to prevent overdoses by providing vulnerable people with an alternative to the increasingly dangerous opioids on the street.

In this case, the London, Ontario-based program provided clients with a daily dose of prescription opioid pills, as well as basic health care, counseling, and social services.

The result was a rapid decrease in emergency room visits and hospitalizations among the 82 clients studied, the researchers found. And for six years there hasn’t been a single overdose death.

“I think this is a landmark study,” said Thomas Kerr, research director at the British Columbia Center on Substance Use in Vancouver, Canada.

Kerr, who was not involved in the study, acknowledged that SOS programs are controversial and have their critics. Concerns included the possibility of opioid pills being sold or of people crushing and injecting the pills, posing a risk of overdose or infection.

However, due to a lack of data, criticism of a safer supply has been expressed, said Kerr.

“The whole conversation has been overshadowed by misinformation,” he said. “When it comes to life and death, we cannot rely on people’s opinions.”

Kerr said he hopes the new findings “will put a damper on some of the misinformation.”

The study was published September 19 in the CMAJ (Journal of the Canadian Medical Association). It comes amid an ever-worsening opioid epidemic.

In the United States, opioid overdose deaths have been rising for years, and the situation worsened after the onset of the pandemic. In 2020, nearly 92,000 Americans died from drug overdoses — mostly with opioids, according to the US Centers for Disease Control and Prevention.

The crisis was mainly fueled by illicitly manufactured versions of the painkiller fentanyl, a synthetic opioid 50 times stronger than heroin, health officials say. Illegal fentanyl is sold in a variety of forms, including pills that look like other prescription opioids. It is also commonly mixed with other illegal drugs, such as cocaine and heroin, to increase their potency. The result is that users are often unaware that they are taking fentanyl.

Safer Supply programs are based on the principle of harm reduction—that overdoses, infections, and other consequences of opioid addiction can be prevented without requiring people who abuse drugs to be completely abstinent.

The new findings come from a program started in 2016 at the London InterCommunity Health Centre. It provides its customers with hydromorphone (Dilaudid) tablets dispensed daily, as well as many other services – including primary health care, treatment for infections such as HIV and hepatitis C, counseling and assistance with finding housing, and other social services.

The researchers, led by Tara Gomes of Unity Health Toronto, examined data from all 94 clients who participated in the program between 2016 and March 2019. They compared 82 of those people to 303 people who had been diagnosed with opioid addiction and who had not participated in the program.

Over a year, the study found, emergency department visits and hospitalizations fell among program clients, while they were flat in the comparison group. And while patients had medication costs — covered by Ontario’s prescription drug plan — their annual non-primary health care costs plummeted: from an average of $15,600 to $7,300.

Again, there was no significant change in the comparison group.

dr Sandra Springer is an Associate Professor at the Yale School of Medicine in New Haven, Conn. who helped develop practice guidelines for the American Society of Addiction Medicine.

“This study is further evidence that programs that meet patients where they are and provide easy access to clinical care to treat opioid use disorders can save more lives and reduce health care costs,” said Springer, who does not attend was involved in the research.

Opioid addiction itself can be managed with drug-assisted therapy, which includes counseling and drugs such as buprenorphine, methadone, and naltrexone.

“While this SOS program did not make traditional drugs used to treat opioid use disorders available to all participants, these drugs were available to patients in the program,” Springer noted.

And, 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 to what extent SOS programs will spread. In 2020, Health Canada announced funding for several additional pilot programs. And last year, New York City opened two overdose prevention facilities — where people with opioid addiction can take the drugs in a clean, supervised environment and be connected to health and social services.

The sites are the first publicly recognized overdose prevention centers in the United States.

Kerr said that as the opioid crisis worsens, “reacting to the status quo is not enough.”

“We have to try new approaches,” he said, “and evaluate them scientifically.”

More information

The US National Institute on Drug Abuse has more on opioid use disorders.

SOURCES: Thomas Kerr, PhD, Director, Research, British Columbia Center on Substance Use, Professor, Social Medicine, University of British Columbia, Vancouver, Canada; Sandra Springer, MD, Associate Professor of Medicine, Yale School of Medicine, New Haven, Connecticut; CMAJ, September 19, 2022, online



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