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The data ‘speaks’

Prescriptions, hospitalizations increase: Pharmacy researchers assess B.C.'s safer opioid policy


By Jackey Locke

A Memorial University study is providing some of the first evidence of the impact of a widely debated policy on opioid overdoses.

Yellow man in his late 30s with glasses wearing a light dress shirt leans against a wall
Dr. Hai Nguyen is a tier 2 Canada Research Chair in health policy evaluation and health-care sustainability at Memorial University.
Photo: Rich Blenkinsopp

In 2020 British Columbia began offering a free and safer supply of prescribed opioids.

Health professionals in that province prescribe pharmaceutical-grade opioids to people with opioid-use disorder at a high risk of overdose or poisoning.

Safer opioid supply policies aim to reduce opioid-related overdoses and deaths due to the use of increasingly toxic opioids from the illegal market.

Safer supply diverted to illegal market

Dr. Hai Nguyen, an associate professor and tier 2 Canada Research Chair in health policy evaluation and health-care sustainability in the School of Pharmacy, says he has always been interested in generating rigorous, timely evidence on emerging health policies relating to substance use.

He and his team found that two years after its launch, British Columbia’s safer opioid supply policy was associated with a higher prescription of safer-supply opioids, accompanied by a significant increase in opioid-related hospitalizations.

“We need to remember that it was the high rates of opioid prescribing during the 1990s that led to today’s opioid crisis.” — Dr. Hai Nguyen

One of his biggest concerns is that people, including youth, who never use opioids could get access to and may become addicted to opioids and overdose as a result of diverted safer supply, which refers to prescribed, safer opioids being sold on the illegal market.

As a health policy researcher, Dr. Nguyen says he approaches any analysis with no prior beliefs or biases and lets the data “speak” for itself.

“Our findings align with emerging evidence of diversion of safer supply opioids. So, to some extent, I am not surprised by our finding that the policy led to more opioid-related hospitalizations.”

Alternative approach

Dr. Nguyen says he hopes his findings will inform policy-makers and spark more discussions on whether or not to expand upon the policy in British Columbia or to adopt it in other Canadian provinces.

“I would urge governments to be vigilant about the unintended consequences of this policy, especially the diversion of opioids to youths,” he said. “We need to remember that it was the high rates of opioid prescribing during the 1990s that led to today’s opioid crisis. We certainly do not want to aggravate a problem that we have started out to fix.”

An alternative is to ensure greater access to substance use treatment for individuals with opioid addiction, combined with stricter trade policies and law enforcement to directly combat the illegal drug market, he says.

The paper, British Columbia’s Safer Opioid Supply Policy and Opioid Outcomes, led by Dr. Nguyen with co-authors Drs. Shawn Bugden, dean, School of Pharmacy, Memorial University, and Shweta Mital (PhD’21), assistant professor, pharmacoeconomics, University of Manitoba College of Pharmacy, was published in the most recent issue of JAMA Internal Medicine.

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