New research in British Columbia has found that people with an opioid-use disorder who were prescribed a day or more’s worth of opioids were 61-per cent less likely to die the following week than those who did not.
The study published in the peer-reviewed British Medical Journal analyzed data about acute health-care use, overdoses and deaths among 5,882 people with substance use disorders who filled a prescription under B.C.’s Risk Mitigation Guidance between March 2020 and August 2021. The study group was similar to a second group that did not get a prescription.
In addition to finding those with the prescription were less likely to die, researchers found they were also 55-per cent less likely to overdose the week after having it filled.
“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 health sciences professor at Simon Fraser University, in a Thursday press release.
“Like naloxone and needle distribution programs, prescription of regulated drugs is a harm reduction intervention and provides benefits only while prescriptions are being used.”
The study was a collaboration between scientists, people with lived experience, Simon Fraser University, the University of British Columbia, the University of Victoria’s Canadian Institute for Substance Use Resarch, the BC Centre on Substance Use, the Centre for Advancing Health Outcomes, the BC Centre for Disease Control, and the First Nations Health Authority.
Its findings appear to complement those of the B.C. Coroners Service expert death review panel, which, in December, touted expanded access to safer supply as “fastest way to reduce deaths” amid the province’s worsening toxic drug crisis.
That panel, however, also vouched for prescription-free safer supply as the most viable, scalable short-term option to save lives, as an estimated 225,000 British Columbians are currently at risk of drug injury or death.
“The current medical model for provision of safer supply faces a number of overwhelming challenges, including scalability, geographic reach within the province, and the adequacy of available drugs to meet the needs of people accessing the unregulated drug market,” said its chair, Michael Egilson, at the time.
Mental Health and Addictions Minister Jennifer Whiteside has flatly rejected the suggestion of prescription-free substances.
Prescribed safer supply is only accessed by about 5,000 people in B.C. each month. To date, the toxic drug crisis has claimed more than 13,000 lives since April of 2016, and takes about seven lives each day.
British Columbia’s Risk Mitigation Guidance was developed during the pandemic to support health-care providers in supplying pharmaceutical alternatives to those at risk during quarantine and isolation.
In a Thursday interview, the BC Centre for Disease Control’s Dr. Amanda Slaunwhite said the research analyzing the prescriptions stemming from those guidelines found a “significant reduction” in chances of the patient’s death.
“People who received four days or more of opioid-risk mitigation medication — that was associated with an over 90-per cent reduction in death in the subsequent week,” she said.
Dr. Julian Somers, a clinical psychologist and professor in SFU’s Faculty of Health Sciences, took issue with some of the study authors’ “interpretation” of their findings. He suggested they did not adequately account for other environmental factors that could have reduced their study group’s risks of death.
“These authors report that in their sample about 85 per cent were reliant on income assistance … on average, there was a very high prevalence of housing instability and as well as mental illness,” said Somers, whose research areas include mental health and substance use.
“In people living with these kinds of challenges, receiving medication is likely partially an indication that they’re doing relatively well. They’re able to get somewhere and receive a drug, and that in turn, might reflect a lower likelihood of dying.”
Slaunwhite, however, said the background on the study groups’ levels of income, access to housing, previous incarceration, and interactions with the health-care system suggests instead that those who received prescriptions were “among probably the more sick and more vulnerable population.”
“We really interrogated the data to be able to say confidently that it was the prescription that had that impact” of reducing death and overdose, she explained.
“We were able to do that by creating a very robust control group who were extremely similar to the people who had received the medication.”
Somers also suggested that some of those in the study’s sample may have sold their prescribed alternatives, thereby gaining “additional material support for their lives,” which could make them less likely to die and skew the study’s findings.
“It’s leaving unaddressed things that are known to be directly related to people’s likelihood of improvement. That’s addressing their housing, addressing unemployment — really things that all go together. The term ‘social inclusion’ is used in this field. We’re turning a blind eye to all of those things,” Somers said.
Slaunwhite acknowledged the study did not account for diversion of prescribed drugs, with insufficient available administrative health data on the topic, but said it’s unlikely researchers would have observed such dramatic percentage decreases in the odds of death or overdose if the prescription recipients were selling, rather than taking, the drugs.
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