Safer Supply of Opioids and Diversion

"Diversion of safer opioid supply drugs was examined in six qualitative studies (Giang et al., 2023; Haines & O'Byrne, 2023a; Haines et al., 2022; Kalicum, 2023; Kolla et al., 2021; McMurchy & Palmer, 2022) and one quantitative study (Brothers et al., 2022). These studies found that diversion does occur (Brothers et al., 2022; Haines et al., 2022; Kolla et al., 2021; McMurchy & Palmer, 2022), although the extent of diversion remains unknown. Importantly, safer opioid supply programs include measures and protocols to prevent and address diversion, including urine drug screens, lock boxes and observed dosing (Atkinson, 2023; Kalicum, 2023; Kolla et al., 2021; McMurchy & Palmer, 2022; Selfridge et al., 2022; Waraksa et al., 2022). Despite concerns regarding the diversion of hydromorphone from safer opioid supply programs, unregulated fentanyl remains the largest contributor of death in both Ontario (Public Health Ontario, 2023) and British Columbia (British Columbia Centre for Disease Control, 2021; Owens, 2023), Canada with no substantial changes in occurrence of deaths related to prescription opioids use, including hydromorphone. These factors indicate that diversion in the context of safer opioid supply requires further study, and ongoing refinement and sharing of protocols to address diversion within safer opioid supply programs is likely the most effective response."