Evaluation of innovative risk mitigation services in the context of dual crises of COVID-19 and overdose among people who use opioids in Vancouver, BC

This award is co-funded by Health Research BC, through CIHR’s Operating Grant: COVID-19 Mental Health & Substance Use Service Needs and Delivery Funding Opportunity.

 

Principal Investigators Dr. Kanna Hayashi, Research Scientist at the BC Centre on Substance Use (BCCSU) and St. Paul’s Hospital Chair in Substance Use Research and Assistant professor in the Faculty of Health Science at Simon Fraser University (SFU) along with Dr. Kora DeBeck, Research Scientist at the BCCSU and Associate Professor in the SFU School of Public Policy aim to conduct preliminary evaluation of two novel measures introduced by the BC government in March 2020 to address the dual crisis of overdose and COVID-19.

 

Specifically, these measures include expanding the opioid agonist treatment (OAT) prescription guidelines and pandemic prescribing of pharmaceuticals (e.g. opioids) to people who use illicit drugs. By providing pharmaceutical alternatives to the toxic illicit drug supply, the interventions are intended to reduce physical encounters involved in obtaining illicit drugs and the use of toxic street drugs, thereby supporting both overdose and COVID-19 prevention efforts. To date, however, the impacts of these interventions have not been evaluated.

 

The proposed BC-based research aims to fill critical knowledge gaps by examining the reach and preliminary impacts of pandemic prescribing and expanded OAT prescription services among people who use opioids in urban Vancouver. Through this work, the research team, which consists of highly productive investigators and knowledge users with direct clinical and policy expertise, seeks to inform efforts to improve the delivery and effectiveness of the interventions.

End of Award Update – April 2023

Most significant outputs so far

We have successfully conducted interviews with 1,264 people who use drugs (including 911 people who use opioids) in Vancouver between July 2020 and November 2021, meeting our target sample size. We have developed multiple infographic summaries of data from the first wave of surveys (conducted in 2020), showing access to and perceived effects of the risk mitigation services among people who use drugs. These findings have been shared with and presented to a range of stakeholders, including those involved in developing and implementing the clinical guidelines for opioid agonist therapies and risk mitigation prescribing.

 

In addition, three manuscripts have been developed in collaboration with people with lived/ing experiences, addiction medicine physicians, clinician scientists and policy makers. The first manuscript demonstrated low awareness of risk mitigation prescribing among people who use drugs has been published in Harm Reduction Journal, while the second manuscript that showed the inability to contact a medication prescriber when in need among individuals accessing opioid agonist therapy has been published in Addiction Science and Clinical Practice.

 

The third manuscript that examines access to opioid agonist therapy and risk mitigation prescribing/prescribed safer supply over time is currently under review for peer-reviewed publication. Additionally, two analyses (one that examine the impacts of risk mitigation prescribing/prescribed safer supply and another that characterizes preferred pharmaceutical opioids among people who use opioids) are currently in progress for peer-reviewed publication as well.

Impacts so far

Our study findings have already been utilized to inform the implementation of the Prescribed Safer Supply initiative. Building on the risk mitigation prescribing, the BC government launched the Prescribed Safer Supply initiative in 2021 and put more emphasis on overdose prevention. At their request, we shared our study findings with the BC Ministry of Mental Health and Addictions.

Potential influence

Our research has significant potential to continue to inform policies and programs regarding safer supply and opioid agonist therapies. Of note, as safer supply initiatives are rapidly evolving, we have amended our survey questionnaire on an ongoing basis in an effort to capture the potential impacts of policy developments in a timely manner. Importantly, we have engaged a range of stakeholders (e.g. people with lived/ing experiences, addiction medicine physicians, policy makers, etc.) in developing and updating the survey questions so that the data we collect are meaningful and useful for informing further developments of these new interventions.

Next steps

As more recently collected data have become ready for analyses, we plan to develop more infographic summaries and analyses/manuscripts in this area. As we have done to date, we plan to continue to engage stakeholders in developing and disseminating the research outputs.

Useful links