The risks of ending safer supply drugs programs

Posted on January 28, 2024 in Health Debates

Source: — Authors: – Opinion/Editorials
January 27, 2024.   By Star Editorial Board

If the programs are maintained and expanded, safer supply could ultimately help clients address other health issues.

Last May, it looked like safer supply programs would enjoy long and productive lives. But looks can be deceiving, and just eight months later, many of those programs are on life support.

The programs, which typically provide pharmaceutical-grade hydromorphone to people with opioid use disorders, have been controversial from the outset, with critics like federal Conservative leader Pierre Poilievre charging that they perpetuate drug addiction.

Poilievre introduced a motion in May to end the programs, but it was quickly defeated by a vote of 209-113. That resounding support suggested that federal funding for safer supply was safe for the foreseeable future.

But that was then. Now, 21 of 24 federally funded safer supply programs are in jeopardy, as their contracts will expire in March. And with just two months until then, the feds have given no indication that they’ll renew their commitment to any of them.

Ottawa’s silence on the matter is all the more disturbing given the recent, dramatic increase in overdose deaths — and the mounting evidence in support of safer supply.

When the Public Health Agency began surveilling the situation in 2016, less than 3,000 people died from opioid toxicity. That number, as bad as it is, was easily surpassed in just the first half of last year, with nearly 4,000 people succumbing by the end of June.

Opioids are now claiming roughly 22 Canadian lives each day, or nearly one per hour. If nothing else, those stats reveal that opioid toxicity is a public health emergency. But there is something else: Eighty per cent of deaths involve non-pharmaceutical (street) drugs, which are often contaminated with fentanyl and other substances.

It’s reasonable to assume, then, that we can reduce overdose deaths by replacing those street drugs with quality-controlled, pharmaceutical-grade opioids. And that’s precisely what the evidence shows.

Just last week, for example, a British Columbia study published in the British Medical Journal last week found that providing prescription opioids to drug users was associated with a dramatic reduction in overdose deaths.

That’s just one of a growing number of studies attesting to the benefits of safer supply. In a rapid review of the literature published last July, the Ontario Drug Policy Research Network analyzed many more, including 15 peer-reviewed publications.

Most studies found that safer supply programs reduced opioid use among program clients, with a consequent reduction in fatal and non-fatal overdoses, hospitalizations, and financial burden on the health care system.

Furthermore, program providers and clients both reported that clients enjoyed improved mental and physical health, and greater financial stability, while receiving pharmaceutical opioids.

The evidence from these and other studies is so compelling that the British Medical Journal published an editorial last week stressing the importance of “investing in safer supply interventions supported by a growing observational evidence base.”

Despite much of that evidence coming from Canada, Ottawa remains noncommittal about its future support for the programs. Consequently, in an open letter published in December, more than 130 substance abuse experts called on the government to continue its support for both the programs and their evaluation, to ensure they’re safe for both clients and communities.

The experts also stressed that if the programs are eliminated, many clients will lose their primary health care since they receive it through the initiatives. And since many clients have complex mental and physical health needs, that will not only elevate the risk of overdose deaths, but of a host of other health problems as well.

On the other hand, if the programs are maintained and expanded, safer supply could ultimately help clients address other health issues, including ones that led to their addictions. While it’s not a magical cure all – nothing is – it’s clearly effective at addressing an urgent problem, and may offer valuable health benefits downstream.

And all it takes is continued support from the feds, whose initial commitment led to Canada becoming a world leader in developing and evaluating safer supply programs. Turning back now won’t just kill those programs; it could also end the lives of thousands of Canadians who depend on them.

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