Contrasting studies show possible impact of safer supply in B.C.

Peer-reviewed research is emerging about the possi‐ ble effects of British Columbia's safer supply program, with two studies in international medical journals casting the strategy in a different light.

One found the program which provides prescription alternatives to toxic illicit drugs - was associated with a reduced risk of death from overdose and other causes among opioid-using partici‐ pants, while the other con‐ cluded the strategy was asso‐ ciated with a significant in‐ crease in opioid overdose hospitalizations across the community.

The authors of the studies say the two sets of results aren't contradictory; instead, they ask different questions about the policy, which was introduced in 2020.

Safer supply has since be‐ come a lightning rod for crit‐ ics, including federal Opposi‐ tion Leader Pierre Poilievre, who has pledged to shut it down if he becomes prime minister.

1st study finds 'relative increase' in hospitaliza‐ tions

Shawn Bugden is an au‐ thor of one of the studies, which found an almost 63 per cent "relative increase" in the opioid overdose hospital‐ ization rate across B.C. after the introduction of safer sup‐ ply. The study was published in JAMA Internal Medicine in January.

He said in an interview there could be multiple ex‐ planations, including the di‐ version of safe-supply drugs onto the illicit market, which the study says could occur "for various reasons, includ‐ ing to purchase unregulated fentanyl."

Increased toxicity of illicit drugs during the period of the study could also be to blame, but Bugden said there was no similar increase in Saskatchewan or Manitoba. Those provinces do not have safer supply and were chosen as controls for the study because they had com‐ parable data to B.C.

The authors were not try‐ ing to imply "causality" be‐ tween safer supply and the spike in overdose hospitaliza‐ tions, said Bugden, dean of the school of pharmacy at Memorial University of New‐ foundland.

"Is it possible that putting more opioids into the system is not necessarily the solu‐ tion, even though a commonsense approach to suggest a safer supply of drugs would be helpful? I don't think we really know those answers," he said.

"But they're not inconsis‐ tent with the fact that some individual people may bene‐ fit. I think we just need more in-depth follow up," he ad‐ ded.

WATCH | No evidence safe-supply drugs being di‐ verted into illegal market, say police:

He said "careful evalua‐ tion" was needed to make sure safer supply was work‐ ing as intended.

"And on the other end of the spectrum, I think it would be absurd to indicate that our paper is definitive evi‐ dence that safer drug supply does not work."

The study didn't find a statistically significant change in deaths from apparent opi‐ oid poisoning.

2nd study finds reduc‐ tion in overdose deaths

Dr. Paxton Bach is one of the authors of the other study, published in the British Medical Journal in Jan‐ uary. It concluded that one day or more of prescription opioid dispensation was as‐ sociated with "significantly reduced all-cause mortality" as well as overdose deaths over the next week.

There was a 55 per cent reduced risk of overdose death in the week after re‐ ceiving at least one dispensa‐ tion of safe-supply opioids. Four or more dispensations of safe-supply opioids were associated with a 91 per cent reduction in risk of death from all causes in the follow‐ ing week.

Bach said mortality reduc‐ tion within a one-week time‐ frame may not seem signifi‐ cant, but the benefits add up.

"If somebody stays on this program for six weeks, or 12 weeks or 24 weeks or a year, then that risk [reduction] re‐ ally starts to accumulate," he said.

"The total reduction really depends on how long you're participating."

Bach said the JAMA study demonstrated the possibility of an increase in opioid-re‐ lated hospitalizations in B.C. compared with other provinces.

"But I think it's very diffi‐ cult to convincingly link that to the prescribed safer-sup‐ ply policy," said Bach, an ad‐ diction medicine physician at St. Paul's Hospital in Vancou‐ ver and co-medical director of the B.C. Centre on Sub‐ stance Use.

He said the other re‐ searchers were clear about their use of an approach that he said assumed everything would have stayed the same in the absence of safer sup‐ ply.

"I think that is, in these times, a very tenuous as‐ sumption," Bach said.

"There are many things changing these days in our health-care system that are not necessarily similar be‐ tween provinces, and in par‐ ticular, as far as the toxic drug crisis goes, we are all experiencing rapidly evolving versions of the crisis."

Bugden said of the BMJ study that it was "puzzling" that the research didn't regis‐ ter benefits for acute care visits, and one week was a "narrow window" to examine.

"We really want to see whether, in the long term, this is resulting in [fewer] deaths at the individual level. And if that works well enough, then we should see it at the population level, eventually, as well," he said.

Bach said it was "unrea‐ sonable" to expect the data to register changes at the population level when fewer than five per cent of people at the highest risk of over‐ dose in B.C. were accessing safer supply.

About 70,000 people had signals of opioid use disorder and 5,356 of them received opioid dispensations during the BMJ study's period. Among nearly 42,000 people with stimulant-use disorder, 1,061 received safer-supply stimulants, the study says. Drug diversion

B.C. declared the opioid crisis a public health emer‐ gency in April 2016. Since then, more than 14,000 peo‐ ple have died, most of them from highly potent fentanyl.

A statement from the Min‐ istry of Mental Health and Addictions said the BMJ study showed safer supply was preventing deaths and helping people stabilize their lives.

Asked about the JAMA study, the ministry said it "overlooks other factors that influence hospitalizations," such as the toxicity of the illi‐ cit drug supply, as well as ad‐ mitting practices and the availability of health-care ser‐ vices.

The issue of potential drug diversion from the safer supply system has been in the national spotlight since police in Prince George, B.C., issued a news release last month saying trafficking in‐ vestigations were finding in‐ creasing amounts of medica‐ tions used in the program.

The statement triggered criticism of B.C.'s policy from Poilievre and from Alberta Premier Danielle Smith, who worried the drugs would end up in her province.

At the time, B.C. Solicitor General Mike Farnworth said Mounties had told him there was no evidence of wide‐ spread diversion of safersupply medications.

On Monday, RCMP in Prince George announced two people had been ar‐ rested over allegations they were trafficking in safer-sup‐ ply drugs. The Mounties said the suspects were allegedly seen "exchanging illicit drugs for safer supply drugs."