Prescribed Safer Supply Programs

"Opioid toxicities are a public health crisis in North America that has been amplified in severity by the COVID-19 pandemic. In Canada, the annual number of opioid-related deaths increased from 3007 to 6222 between 2019 and 2021, with more than 250 000 years of life lost in 2021 alone.1 Similar findings have been observed in the USA.2,3 Responses to this emergency have included measures to improve access to opioid agonist treatment (OAT) and expand harm reduction services, such as naloxone distribution and supervised consumption services.4–6 While existing measures address the treatment of substance use disorder, reversal of opioid overdoses, and the safety of drug use environments, additional measures are needed to address the potent, unpredictable nature of the unregulated drug supply—the principal determinant of overdose deaths—particularly for the group of people who do not desire OAT or have not been retained on it previously.7

"Prescribed safer opioid supply (SOS) programmes, also called prescribed alternatives, are novel interventions that seek to prevent unregulated drug overdose by minimising exposure to the toxic drug supply.8 In Ontario, this practice typically involves prescribing short-acting opioids (eg, hydromorphone) to individuals at high risk of overdose for take-home, unsupervised use, with many also receiving observed doses of long-acting opioids at the pharmacy. Prescribed SOS programmes can also include social services to facilitate engagement with care and address social determinants of health.8 Importantly, prescribed SOS is conceptualised as a harm reduction intervention which complements available treatment options by providing individuals at high risk of overdose with an alternative to the toxic drug supply. Emerging research suggests that SOS is associated with outcomes aligned with these objectives, including reduced rates of overdose, decreased reliance on the unregulated drug supply, increased retention in primary care, access to HIV and hepatitis C treatments, decreased health services use, and reduced health-care costs.9–14 Furthermore, a population-based evaluation of prescribed SOS in British Columbia found that prescription opioid dispensations of 1 day or more were associated with reduced all-cause and overdose-related mortality in the subsequent week.15"