Safer Opioid Supply programs: Hydromorphone prescribing in Ontario as a harm reduction intervention to combat the drug poisoning crisis.

Autor: Schmidt RA; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada., Guta A; School of Social Work, University of Windsor, Windsor, ON, Canada., Rai N; Parkdale Queen West Community Health Centre, Toronto, ON, Canada.; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada., Sereda A; London InterCommunity Health Centre, London, ON, Canada., O'Reilly E; South Riverdale Community Health Centre, Toronto, ON, Canada., Hales J; Regent Park Community Health Centre, Toronto, ON, Canada., Kolla G; Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC, Canada., Strike C; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. carol.strike@utoronto.ca.
Jazyk: angličtina
Zdroj: Canadian journal of public health = Revue canadienne de sante publique [Can J Public Health] 2024 Dec 10. Date of Electronic Publication: 2024 Dec 10.
DOI: 10.17269/s41997-024-00979-2
Abstrakt: Setting: The crisis of unregulated fentanyl-related overdose deaths presents a significant public health challenge. This article describes the implementation and evaluation of four Safer Opioid Supply programs (SSPs) in Ontario, one in London and three in Toronto.
Intervention and Implementation: SSPs aim to curtail overdose fatalities while connecting individuals using drugs to healthcare services. The programs involve a daily dispensed prescription of immediate-release hydromorphone tablets for take-home dosing alongside an observed dose of long-acting opioids like slow-release oral morphine. Implemented within a multidisciplinary primary care framework, these programs emphasize patient-centred approaches and comprehensive health and social support.
Outcomes: In our study conducted in 2020/2021, clients and service providers reported that receiving pharmaceutical opioids through these programs improved the clients' health and well-being. The regulated supply was reported to lead to decreases in overdose incidents, use of unregulated substances, and criminalized activities. Increased engagement with healthcare and harm reduction services and improvements in social determinants of health, such as food security, were also reported. Despite these positive outcomes, some implementation challenges, including capacity issues and provider burnout, were described by service providers.
Implications: Our findings suggest that the combination of safer supply, wrap-around support, and harm reduction within primary care settings can lead to increased healthcare engagement, HIV/HCV prevention, testing, and treatment uptake, reducing the burden of infectious diseases and overdose risk. SSPs have the potential to meaningfully reduce overdose rates, address the ongoing overdose crisis, and if scaled up, influence population-level outcomes.
Competing Interests: Declarations. Ethics approval: The study was approved by the University of Toronto Research Ethics Board (Protocol: 40140). Consent to participate: All participants provided verbal consent. Consent for publication: Not applicable. Conflict of interest: Schmidt, Guta, and Strike have no conflicts to declare. Rai is a prescriber in the Safer Opioid Supply program based out of the Parkdale Queen West Community Health Centre. Sereda is a prescriber in the Safer Opioid Supply program based out of the London InterCommunity Health Centre. O’Reilly is a prescriber in the Safer Opioid Supply program based out of the South Riverdale Community Health Centre and his position is partially funded through the Centre on Drug Policy Evaluation. Hales is a prescriber in the Safer Opioid Supply program based out of the Regent Park Community Health Centre. Kolla is supported by a Banting postdoctoral fellowship from CIHR and a postdoctoral fellowship from the Canadian Network on Hepatitis C (CanHepC). Separate from this study, Kolla received funding from London InterCommunity Health Centre’s Substance Use and Addictions Program grant to conduct an independent preliminary evaluation of their Safer Opioid Supply program.
(© 2024. The Author(s).)
Databáze: MEDLINE
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