Safer opioid program cuts risk of overdose deaths, lowers emergency department use

Prescription opioids may cut risk of overdose deaths and lower health care costs for patients with opioid use disorder.

A Canadian study found a safer opioid supply (SOS) program “led to important declines” in numbers of emergency department visits, inpatient hospital admissions, admissions for incident infections, and health care costs not related to primary care or outpatient medications.

"These positive impacts were seen very quickly after entering the program," lead author Tara Gomes, PhD, Unity Health Toronto and ICES, Toronto, Ontario, said in a news release. "We did not see similar changes in a matched group of people with opioid use disorder not enrolled in the program, suggesting that these changes seen in safer supply clients were because of participation in the program, and were not influenced by outside factors."

How it works

Like in the United States, opioid overdoses have become a major, continuing public health issue. Driven primarily by drug contamination with fentanyl, Canada had more than 29,000 opioid overdose deaths from January 2016, to December 2021, the study said.

Across Canada, access to naloxone to reverse overdoses, supervised consumption and overdose prevention sites, and opioid agonist therapy programs have averted some deaths. But distribution of those interventions has been slow and uneven, according to the study.

Several jurisdictions have begun SOS programs that prescribe pharmaceutical opioids as an alternative to fentanyl-laced drugs available on the street. Generally the prescription drugs are dispensed daily with a combination of immediate-release hydromorphone and long-acting opioid medications, the study said.

Results

So far there is relatively little research on “the real-world impacts of SOS programs,” so the study examined Canada’s first formal SOS program at the London InterCommunity Health Centre (LIHC), which began in 2016.

LIHC had 82 clients enrolled in the program. After a year, they had fewer ED visits and hospital admissions, and lower total health care costs not related to primary care or outpatient medications, than they did the year before. There was no corresponding change in a matched group of patients who did not access the SOS program, the study said.

After a year, the SOS participants had greater medication costs, but the price of prescribed opioids was “relatively modest,” suggesting the patients had more treatment for conditions such as HIV and hepatitis C, the study said. The authors noted primary care costs likely would increase for SOS clients, but those would represent better care, which usually would be considered a positive outcome.

Reaching those who need it

The findings “suggest that the LIHC SOS program is reaching a population of people at high risk of fatal overdose and complications form unregulated drug use who may not have derived benefit from existing treatment options,” with SOS programs potentially playing an important role in opioid use disorder treatment, the study said.

"There have been concerns raised about SOS programs, and both the improvements in health services usage and lack of negative outcomes detected among clients provides important reassurance about the safety of these programs," coauthor Dr. Gillian Kolla, PhD, said in the news release. Kolla is postdoctoral research fellow of the Canadian Institute for Substance Use Research at the University of Victoria in Victoria, British Columbia.

"It is important to note that the London program also offers comprehensive primary care and social supports to safer supply clients, so it will be important for future research to examine the impact of different program elements on client outcomes," Kolla said.

The authors noted a number of limitations to the study, including use of just one program and potential underestimation of overdoses among clients treated in the community, not at hospitals.

The study “Clinical outcomes and health care costs among people entering a safer opioid supply program in Ontario,” was published Sept. 19, 2022, in CMAJ, the Canadian Medical Association Journal.