Theme: Epidemiology & Public Health Research Year: 2024
Background: At the onset of the COVID-19 pandemic, clinical guidance was issued in British Columbia, Canada that allowed healthcare providers to prescribe opioid and stimulant substitutes for illicit substances, also known as Risk Mitigation Guidance (RMG) prescribing, to support quarantine and isolation. This intervention has been described as pharmaceutical alternatives to the toxic drug supply or ‘prescribed safer supply’.
Methods: We identified people who received RMG opioid or stimulant dispensations from March 27, 2020 to August 31, 2021 using provincial linked health administrative data for persons diagnosed with opioid or stimulant use disorder. RMG recipients were matched 1:1 with control groups constructed using investigator-selected propensity-score and high-dimensional propensity score (hdPS) matching. Marginal structural models, executed on weekly time steps, were used to determine the impact of dispensations on outcomes.
Results: In total, 5882 persons were dispensed Risk Mitigation Guidance (RMG) medications (5356 opioid RMG and 1061 stimulant RMG, of which 535 both) for a total of during the study period. RMG opioid dispensations of ≥ 1 days were associated with reduced all-cause and overdose mortality in the subsequent week. The protective effect of RMG opioid dispensations increased with the number of days RMG medications were dispensed. Opioid and stimulant RMG dispensations did not significantly modify the odds of overdose-related acute care visits.
Conclusion:
Pharmaceutical alternatives to the illicit drug supply are a promising intervention to reduce mortality.