Landmark study finds prescribing opioids dramatically reduced deaths, overdoses for drug users in B.C.

A study conducted by the B.C. Centre for Disease Control has found that prescribing medical-grade opioids dramatically reduced the rates of deaths and overdoses for drug users living in B.C.

The study, published in the British Medical Journal, is described as "the first known instance of a North American province or state providing clinical guidance to physicians and nurse practitioners for prescribing pharmaceutical alternatives to patients at risk of death from the toxic drug supply."

Researchers looked at anonymized health-care data of 5,882 people between March 2020 and August 2021, all of whom had opioid or stimulant use disorder.

Those individuals filled a prescription under the B.C. Risk Mitigation Guide — clinical guidance developed in March 2020 to allow for physical distancing during the COVID-19 pandemic, and to reduce deaths through harm reduction.

That cohort was compared to a second, similar group that did not receive medication under the Risk Mitigation Guidance program.

The analysis found the cohort who were prescribed pharmaceutical-grade opioids had a 61 per cent lower risk of death from any cause the following week, and was 55 per cent less likely to die of an overdose the following week.

It also showed the protective effect increased with the number of days opioid medications were accessed. People who received four or more days of prescription opioids were 91 per cent less likely to die from any cause, and 89 per cent less likely to die from overdose in the following week.

Paxton Bach, a specialist in addictions medicine at St. Paul's Hospital and a co-author of the study, called the findings a "watershed publication" in establishing safe supply as a viable path to significantly curb overdose deaths.

"We saw a profound impact on reduction in somebody's overdose death risk the week after they picked up these drugs, to a degree that is really surprising and has enormous potential," he said.

"This paper is the strongest evidence we have so far, by a large margin, supporting the idea that this can be an effective strategy for reducing overdose death risk."

Over 13,000 deaths in B.C.

The study comes amid record-high overdose deaths in the province. Since B.C.'s public health emergency was declared, 13,112 people in the province have died of toxic drugs.

The latest report from a panel of experts into deaths caused by toxic, unregulated drugs found 13,112 people in the province have died since a public health emergency was declared in 2016, and estimates as many of 225,000 others remain at risk of injury or death. 

Corey Ranger, a clinical nurse specialist unaffiliated with the study who works in harm reduction, said the findings confirm what those in the field have long observed.

"We know prescribed safe supply has the potential to reduce these deaths. Our clinical observations are being validated by this evaluation," he said.

"This signals to leaders we need to continue having evidence and having the expert opinion of people with lived experience guide public policy."

Concerns around diverting prescription opioids

The study did not confirm whether the drug users took the drugs as intended. Bach said a significant criticism of safe supply programs is the fear that prescription opioids will be diverted or shared with those for whom the drugs are prescribed.

"That remains a complicated question," said Bach. "This study design cannot speak to that specific question. But as far as the potential that this intervention has for saving an individual's life who is using these medications instead of a toxic and volatile drug supply, this publication is a really compelling testament to the potential of this type of intervention."

Dr. Thomas Brothers, a resident physician in general internal medicine at Dalhousie University who is not affiliated with the study, said the extent to which mortality was reduced suggests users were themselves using what was prescribed.

"Some of the community of researchers and addiction medicine physicians who are more skeptical of safer supply have particular concerns about the amount of medication that might be diverted to others beyond the person that it was prescribed to," he said.

"I think this may reassure them because the evidence of a mortality benefit means that the patient who is prescribed the medication must be taking some of it."