New research shows access to a safer supply in BC helped reduce overdose risk

published on March 9, 2022

The increasingly toxic and unpredictable drug supply during COVID-19 led many people to seek prescription alternatives, referred to as prescribed safe supply, in order to limit exposure to overdose risk, according to new research published today. However, those who accessed a safe supply still sought illicit drugs because of limitations to prescribing.

Researchers with the BC Centre on Substance Use (BCCSU) interviewed 40 people who accessed a safe supply between February and July 2021, prescribed under the provincial Risk Mitigation Guidance that was rolled out in March 2020 when the global pandemic was declared. The guidelines were developed not for the treatment of substance use disorders, but rather to support individuals who actively use substances to self-isolate, quarantine, or physical distance in order to reduce the spread of COVID-19. They included provisions for prescribing pharmaceutical opioids and stimulants.

Participants interviewed for the study reported that access to prescription drugs allowed them to “take back control” over their drug use. For some, this meant establishing stable drug use patterns that enabled them to avoid cycles of withdrawal and cravings, bingeing and, in some cases, reduce overall drug use. Additionally, participants reported reduced risk of overdose because of a reduced reliance on illicit drugs.

Overdose deaths have increased dramatically since the pandemic was declared, largely attributed to changes in the illicit drug supply that have led to greater toxicity and more contamination of unknown substances. These changes were compounded with disruptions to addiction treatment and harm reduction services, leading to a 66% increase in toxic drug fatalities in Canada between 2019 and 2021.

While 20 of the 40 participants had overdosed in the year prior to accessing safe supply, none had experienced an overdose attributable to prescription opioids or stimulants.

“Safe supply represents a reliable supply,” says study lead author Dr. Ryan McNeil, who’s the Director of Harm Reduction Research at the Yale School of Medicine and a research scientist at BCCSU. “We heard people describe prescription opioids as protective against overdose because they had consistent potency — something especially important amid wide fluctuations in the concentration of fentanyl in down and increasing benzodiazepine contamination.”

While overdose risk was reduced, it wasn’t eliminated entirely. Because prescriptions were primarily intended to manage withdrawal, participants reported supplementing with illicit drugs in order to meet other needs, including enjoyment and pain management.

The findings demonstrate the potential of safe supply approaches to reduce overdose vulnerability by providing people with alternatives to potentially toxic drugs. Researchers say the experiences they observed suggest that safe supply be extended to all people who use drugs and low-barrier, non-prescriber models must also be implemented to maximize access, efficacy, and equity.

The study was published today in the American Journal of Public Health.