People with an opioid use disorder who were prescribed at least one day’s supply of opioids as part of the Province of British Columbia’s Risk Mitigation Guidance were 61 per cent less likely to die in the following week when compared to a similar group of people who did not receive a prescription.
The new research, published this week in the British Medical Journal (BMJ)
, evaluates the effectiveness of Risk Mitigation Guidance. This is the first known instance of a North American province or state providing clinical guidance to physicians and nurse practitioners for prescribing pharmaceutical alternatives to patients at risk of death from the toxic drug supply.
“This is the first study to evaluate prescribing pharmaceutical alternatives at a population level. We demonstrated that providing pharmaceutical alternatives to the toxic and unpredictable street drug supply is associated with a reduction in deaths in the days immediately following,” said Dr. Amanda Slaunwhite, senior scientist with the BC Centre for Disease Control, assistant professor at the University of British Columbia’s School of Population and Public Health, and scientist at the Centre for Advancing Health Outcomes. “With more than 13,300 lives lost in B.C. since 2016 and one of the highest death rates in the country, we need to identify and evaluate interventions that keep people alive.”
The study, Effect of Risk Mitigation Guidance opioid and stimulant dispensations on mortality and acute care visits during dual public health emergencies: retrospective cohort study, was a collaboration between scientists, people with lived and living experience of substance use, and public health professionals from the First Nations Health Authority, BC Centre for Disease Control, Centre for Advancing Health Outcomes, BC Centre on Substance Use, University of Victoria’s Canadian Institute for Substance Use Research, Simon Fraser University and University of British Columbia.
The research looked at anonymized data about acute healthcare use, overdose events and deaths among the 5,882 people with opioid or stimulant use disorder who filled a prescription under Risk Mitigation Guidance between March 2020 and August 2021. This cohort was compared to a very similar cohort that did not receive Risk Mitigation Guidance medication.
In addition to finding that the cohort of people who were prescribed pharmaceutical-grade opioids had a 61 per cent lower risk of death from any cause the following week, this group was also 55 per cent less likely to die of a drug poisoning event (overdose) the following week.
“Deaths from the toxic drug supply are preventable and pharmaceutical alternatives can reduce risk of death by making people less reliant on the unpredictable and toxic drug supply,” said Dr. Bohdan Nosyk, a professor in the Faculty of Health Sciences at Simon Fraser University and scientist at the Centre for Advancing Health Outcomes. “Like naloxone and needle distribution programs, prescription of regulated drugs is a harm reduction intervention and provides benefits only while prescriptions are being used.”
While the study only reports on the immediate benefit associated with receiving pharmaceutical alternatives to the toxic drug supply in the week following a prescription being filled, it showed that the protective effect increased with the number of days opioid medications were dispensed. People who received four or more days of prescription opioids were 91 per cent less likely to die from any cause, and 89 per cent less likely to die from overdose in the following week.
The number of people accessing stimulant prescriptions was relatively small in this analysis. As a result, findings on the reduction in mortality for the approximately 500 people who were prescribed only stimulants were less certain but in line with the effects of opioid prescription, and they show a decrease in the likelihood of acute care visits.
In addition, this study was not able to assess whether someone used their prescription and whether the medications were used as prescribed.
Further research is needed to assess the effectiveness of the Prescribed Safer Supply policy direction introduced in July 2021 which supports clinicians in prescribing pharmaceutical alternatives to the toxic drug supply beyond the context of the COVID-19 pandemic.
- Risk Mitigation Guidance was introduced in British Columbia in March 2020, to support healthcare providers in prescribing select medications, including opioids and stimulants, to people at risk of overdose and withdrawal during the dual public health emergencies of unregulated toxic drugs and the COVID-19 pandemic, when physical distancing and self-isolation were encouraged.
- The Risk Mitigation Guidance tool for clinicians enabled people at high risk of drug poisoning from the toxic, unregulated market to access pharmaceutical-grade drugs of known composition and potency such as:
- Opioids like hydromorphone and M-Eslon (morphine)
- Stimulants like methylphenidate
- Alcohol withdrawal management medications
- The goal of Risk Mitigation Guidance was to reduce the harm caused by exposure to the toxic drug supply and to enable physical distancing, self-isolation, and quarantine measures, where possible, to reduce and prevent the spread of COVID-19.
- Drug poisoning (or overdose) deaths are caused by the increasingly toxic, unregulated drug supply contaminated with fentanyl, benzodiazepines, and other substances.
- According to the latest data from the BC Coroners Service, the province is expected to report an unprecedented number of unregulated drug-related deaths in 2023, with about seven people dying each day.
- Those who are accessing this harm reduction intervention are more likely to live in urban areas, according to previous analyses.
The BC Centre for Disease Control, a part of the Provincial Health Services Authority, provides public health leadership through surveillance, detection, treatment, prevention and consultation services. The Centre provides diagnostic and treatment services for people with diseases of public health importance, and analytical and policy support to all levels of government and health authorities. The BCCDC also provides health promotion and prevention services to reduce the burden of chronic disease, preventable injury and environmental health risks. For more, visit www.bccdc.ca or follow us @CDCofBC. The Provincial Health Services Authority (PHSA) provides specialized health care services and programs to communities across British Columbia, the territories of many distinct First Nations. We are grateful to all the First Nations who have cared for and nurtured this land for all time, including the xʷməθkwəy̓əm (Musqueam), Sḵwx̱wú7mesh Úxwumixw (Squamish), and səlil̓w̓ətaɬ (Tsleil-Waututh) First Nations on whose unceded and ancestral territory our head office is located. We work in partnership with other B.C. health authorities and the provincial government to deliver province-wide solutions that improve the health of British Columbians. For more information, visit www.phsa.ca or follow us @PHSAofBC. The Centre for Advancing Health Outcomes is a multidisciplinary health research centre that bridges research and clinical practice. As the primary investigator-driven health services and outcomes research centre for Providence Health Care (PHC), Advancing Health is jointly affiliated with Providence Research and the University of British Columbia (UBC) Faculty of Medicine and is housed at St. Paul’s Hospital in Vancouver. Learn more about Advancing Health at www.advancinghealth.ubc.ca or follow us @AdvancingHlth.
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