Samantha Young1, Gillian Kolla2, Daniel McCormack3, Tonya Campbell4, Pamela Leece5, Carol Strike6, Anita Srivastava7, Tony Antoniou8, Ahmed M Bayoumi9, Tara Gomes10. 1. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of General Internal Medicine, Department of Medicine, St. Michael's Hospital, Unity Health, Toronto, Ontario, Canada; Interdepartmental Division of Addiction Medicine, St. Paul's Hospital, Vancouver, British Columbia, Canada. 2. Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada. 3. ICES, Toronto, Ontario, Canada. 4. Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada. 5. Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Public Health Ontario, Toronto, Ontario, Canada. 6. Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada. 7. Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; St. Joseph's Hospital, Unity Health, Toronto, Ontario, Canada. 8. ICES, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Family and Community Medicine, St. Michael's Hospital, Unity Health, Toronto, Ontario, Canada. 9. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of General Internal Medicine, Department of Medicine, St. Michael's Hospital, Unity Health, Toronto, Ontario, Canada; MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. 10. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada. Electronic address: Tara.Gomes@unityhealth.to.
Abstract
BACKGROUND: In response to the ongoing overdose crisis, some clinicians in Canada have started prescribing immediate release hydromorphone (IRH) as an alternative to the toxic unregulated drug supply. This practice is often referred to as safer supply. We aimed to identify and characterize patients receiving safer supply IRH and their prescribers in Ontario. METHODS: Using provincial administrative health data, we identified individuals with opioid use disorder prescribed safer supply IRH from January 2016 to March 2020 and reported the number of initiations over time. We summarized demographic, health, and medication use characteristics among patients who received safer supply IRH, and examined select clinical outcomes including retention and death. Finally, we characterized prescribers of safer supply IRH and compared frequent and infrequent prescribers. RESULTS: We identified 534 initiations of safer supply IRH (447 distinct individuals) from 155 prescribers. Initiations increased over time with a peak in the third quarter of 2019 (103 initiations). Patients' median age was 42 (interquartile range [IQR] 34-50), and most were male (60.2%), urban residents, (96.2%), and in the lowest neighborhood income quintile (55.7%), with 13.9% having overdosed in the previous one year. The prevalence of HIV was 13.9%. The median duration on IRH was 272 days (IQR 30-1,244) and OAT was co-prescribed in 62.9% of courses. Death while receiving IRH or within 7 days of discontinuation was rare (≤5 courses;≤0.94 per person-year for each). CONCLUSIONS: Clinicians are increasingly prescribing safer supply IRH in Ontario. Patients prescribed safer supply IRH had demographic and clinical characteristics associated with high risk of death from opioid-related overdose. Short-term deaths among people receiving safer supply IRH were rare.
BACKGROUND: In response to the ongoing overdose crisis, some clinicians in Canada have started prescribing immediate release hydromorphone (IRH) as an alternative to the toxic unregulated drug supply. This practice is often referred to as safer supply. We aimed to identify and characterize patients receiving safer supply IRH and their prescribers in Ontario. METHODS: Using provincial administrative health data, we identified individuals with opioid use disorder prescribed safer supply IRH from January 2016 to March 2020 and reported the number of initiations over time. We summarized demographic, health, and medication use characteristics among patients who received safer supply IRH, and examined select clinical outcomes including retention and death. Finally, we characterized prescribers of safer supply IRH and compared frequent and infrequent prescribers. RESULTS: We identified 534 initiations of safer supply IRH (447 distinct individuals) from 155 prescribers. Initiations increased over time with a peak in the third quarter of 2019 (103 initiations). Patients' median age was 42 (interquartile range [IQR] 34-50), and most were male (60.2%), urban residents, (96.2%), and in the lowest neighborhood income quintile (55.7%), with 13.9% having overdosed in the previous one year. The prevalence of HIV was 13.9%. The median duration on IRH was 272 days (IQR 30-1,244) and OAT was co-prescribed in 62.9% of courses. Death while receiving IRH or within 7 days of discontinuation was rare (≤5 courses;≤0.94 per person-year for each). CONCLUSIONS: Clinicians are increasingly prescribing safer supply IRH in Ontario. Patients prescribed safer supply IRH had demographic and clinical characteristics associated with high risk of death from opioid-related overdose. Short-term deaths among people receiving safer supply IRH were rare.
Authors: Thomas D Brothers; Malcolm Leaman; Matthew Bonn; Dan Lewer; Jacqueline Atkinson; John Fraser; Amy Gillis; Michael Gniewek; Leisha Hawker; Heather Hayman; Peter Jorna; David Martell; Tiffany O'Donnell; Helen Rivers-Bowerman; Leah Genge Journal: Drug Alcohol Depend Date: 2022-04-07 Impact factor: 4.852
Authors: Tara Gomes; Gillian Kolla; Daniel McCormack; Andrea Sereda; Sophie Kitchen; Tony Antoniou Journal: CMAJ Date: 2022-09-19 Impact factor: 16.859