Saving lives with ‘safer opioids’

By Amy Norton
health day reporter

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

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

In this case, the London, Ontario program provided clients with a daily dose of prescription opioid tablets, along with basic health care, counseling and social services.

The result was a rapid decline in emergency room trips and hospitalizations among the 82 clients studied, the researchers found. And in 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 centered on the possibility of opioid pills being sold or people crushing the pills and injecting them, posing a risk of overdose or infection.

But criticism of a safer supply has been made in the absence of data, Kerr said.

“The whole conversation has been clouded by misinformation,” he said. “When we talk about life and death matters, we cannot rely on people’s opinions.”

Kerr said he hopes the new findings will “mitigate some of the misinformation.”

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

In the United States, opioid overdose deaths have been on the rise for years and the situation worsened after the pandemic. In 2020, nearly 92,000 Americans died from drug overdoses – largely involving opioids, according to the US Centers for Disease Control and Prevention.

The crisis was mainly caused by illegal versions of the painkiller fentanyl, a synthetic opioid that is 50 times more potent than heroin, according to health officials. Illegal fentanyl is sold in various forms, including pills designed to 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 launched in 2016 at the London InterCommunity Health Centre. It provides clients with hydromorphone (Dilaudid) tablets, which are distributed daily, as well as many other services, including primary health care, treatment for infections such as HIV and hepatitis C, counseling and support housing and other social services.

The researchers, led by Tara Gomes of Unity Health Toronto, looked at data on the 94 clients who enrolled in the program between 2016 and March 2019. They compared 82 of those people to 303 people diagnosed with opioid addiction who did not participate in the program. program.

According to the study, over one year, emergency room visits and hospitalizations decreased among program clients, while they remained unchanged in the control group. And while clients had drug costs — covered by Ontario’s drug plan — their annual health care costs outside of primary care dropped: from about $15,600, on average, at $7,300.

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

Dr. Sandra Springer is an associate professor at the Yale School of Medicine in New Haven, Connecticut who has 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 for the treatment of opioid use disorders can save more lives and reduce the costs of treatment. health care,” said Springer, who was not involved in the research.

Opioid addiction itself can be treated with drug therapy, which involves counseling and drugs like buprenorphine, methadone, and naltrexone.

“Although this SOS program did not provide traditional medications for the treatment of opioid use disorder to all participants, these medications were available to patients through the program,” Springer noted.

And, she said, other research has shown that when people who use drugs are offered “compassionate care,” they are more likely to accept “evidence-based treatment.”

It remains to be seen how widespread the SOS programs will be. In 2020, Health Canada announced funding for several additional pilot programs. And last year, New York City opened two overdose prevention sites — where people who are addicted to opioids can use the drugs in a clean, supervised setting and be connected to health care and social services. .

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

Kerr said that in the face of a worsening opioid crisis, “the status quo response 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 disorder.

SOURCES: Thomas Kerr, Ph.D., director, research, British Columbia Center on Substance Use, professor, social medicine, University of British Columbia, Vancouver, Canada; Sandra Springer, MD, associate professor, medicine, Yale School of Medicine, New Haven, Connecticut; CMAJ, September 19, 2022, online

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