A study recently featured in the Canadian Medical Association Journal (CMAJ) states, given the urgency of the opioid epidemic and the number of people dying from drug overdoses, Canada needs new and different ways to get people with addictions to back away from taking chances with deadly dangerous street drugs.
That was part of the conclusion to a study published Monday in CMAJ that outlined the MySafe program in Vancouver where prescribed amounts of hydromorphone tablets are provided from biometric dispensing machines to people with addictions.
The CMAJ study gathered data from 46 participants (32 men, 14 women) who took part in the Vancouver MySafe program for at least one month, by accessing controlled amounts of hydromorphone from one of three dispensing sites in Vancouver. The idea of the program is to provide drug users with enough drug products to stave off the negative effects of withdrawal or to at least help the user try to manage withdrawal.
The idea is to dissuade the drug user from seeking a drug solution on the street. Users had reported using unknown amounts of heroin, fentanyl, crystal methamphetamine, crack cocaine, benzodiazepines, cocaine, cannabis, alcohol and other opioids prior to the study.
The biometric feature meant that users only had to apply their palm print in order for the machines to dispense the pharmaceutical-strength drug.
The study participants described a series of positive and negative features of the program.
One result was that several users said having regular access to hydromorphone tablets reduced their spending on illicit drugs. For some users, this meant being able to spend more money on food and clothes, as opposed to spending all or most of their money on street drugs. The authors said this reduced the need for criminalized or stigmatized forms of income generation (e.g., sex work, panhandling, robbery or theft, drug selling) to procure drugs.
Others reported that the tablets did not seem to be strong enough as they had acquired a personal tolerance that did not fully negate the unwanted effects of withdrawal. In some cases, these users went back to the street to seek out stronger doses.
Yet, others reported they liked the 24/7 access to the dispensing machine because it did not tie them down to a schedule such as at a pharmacy or a supervised consumption site.
Also, most users reported that while they still used street drugs alongside the hydromorphone tablets, the tablet dispensing machine meant they had reduced their consumption of street drugs.
"Responses varied, with some participants reporting substantial reductions in the use of illicit drugs and others suggesting they had been spending less money on drugs. Among these participants, having regular access to hydromorphone tablets allowed them to substitute illicit drugs with a prescribed alternative," according to the study.
The urgency of the crisis continues to be seen in Sudbury and across the north. The most recent figures provided by the Community Drug Strategy (April 2023) in Sudbury show 130 residents of the Sudbury and Manitoulin districts died from an opioid-related overdose in 2022.
This compares with 102 opioid-related overdose deaths in the same area in 2021 and 106 overdose deaths related to opioids in 2020.
According to the Quarterly Update on Opioid-related Deaths in Ontario compiled by the Office of the Chief Coroner, in December 2022, five of the top six communities in the province (population greater than 30,000) with the highest opioid toxicity mortality rates per 100,000 — including the top four — were in northern Ontario.
Using the province-wide rate of 8.5 deaths per 100,000 as a benchmark, the four locations that top the list — Thunder Bay (42.4/100,000), Greater Sudbury (29.0), Timmins (28.6) and North Bay (25.8) — all registered at least triple the provincial rate. Sault Ste. Marie, sixth on the list, had a rate of 24.1.
In North Bay–Parry Sound, approximately 50 had died from overdoses in each of the past two years, according to a combination of established and preliminary findings from Public Health Ontario.
"Over the past months, a local task force comprised of community partners has been assessing the feasibility of establishing a safe consumption site for North Bay," the local health unit said. "Unfortunately, the lack of funding to support the start-up and long-term operation and staffing of a safe consumption site has to date prevented us from being able to move forward. Community partners are committed though to continuing to seek funds and work on other initiatives that are known to prevent and reduce overdoses."
According to the City of North Bay's Community Safety and Well-Being Plan, adopted in June 2021, health sector partners, addictions services providers, and the Health Unit received a one-year window to establish and implement harm reduction recommendations while the North Bay Police Service and OPP are to "explore the implementation of a safer opioid supply program," with a timeline of one to three years.
The conclusion of the study noted that "traditional treatments" have not been enough to address the opioid crisis in Canada.
"Given the urgency of the overdose epidemic, novel interventions must be implemented and evaluated to address the risk of overdose and death. Continued reliance on traditional treatments (e.g., opioid agonist therapy, abstinence-based programs) is insufficient to address the overdose crisis. Our study shows one such intervention that can be used as a low-barrier model for the delivery of safer supply programs in settings contending with high rates of overdose death," said the study.
The study was authored by Geoff Bardwell, Andrew Ivsins, Manal Mansoor, Seonaid Nolan and Thomas Kerr; researchers and scientists associated with the School of Public Health Sciences, University of Waterloo; and the British Columbia Centre on Substance Use, Department of Medicine, University of British Columbia, and St. Paul’s Hospital, Vancouver.
The full text of the CMAJ study can be found here.