{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T17:41:16Z","timestamp":1789753276609,"version":"4.0.1"},"reference-count":33,"publisher":"American Medical Association (AMA)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Intern Med"],"published-print":{"date-parts":[[2024,3,1]]},"abstract":"<jats:sec id=\"ab-ioi230090-4\"><jats:title>Importance<\/jats:title><jats:p>In March 2020, British Columbia, Canada, became the first jurisdiction globally to launch a large-scale provincewide safer supply policy. The policy allowed individuals with opioid use disorder at high risk of overdose or poisoning to receive pharmaceutical-grade opioids prescribed by a physician or nurse practitioner, but to date, opioid-related outcomes after policy implementation have not been explored.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi230090-5\"><jats:title>Objective<\/jats:title><jats:p>To investigate the association of British Columbia\u2019s Safer Opioid Supply policy with opioid prescribing and opioid-related health outcomes.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi230090-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This cohort study used quarterly province-level data from quarter 1 of 2016 (January 1, 2016) to quarter 1 of 2022 (March 31, 2022), from British Columbia, where the Safer Opioid Supply policy was implemented, and Manitoba and Saskatchewan, where the policy was not implemented (comparison provinces).<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi230090-7\"><jats:title>Exposure<\/jats:title><jats:p>Safer Opioid Supply policy implemented in British Columbia in March 2020.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi230090-8\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>The main outcomes were rates of prescriptions, claimants, and prescribers of opioids targeted by the Safer Opioid Supply policy (hydromorphone, morphine, oxycodone, and fentanyl); opioid-related poisoning hospitalizations; and deaths from apparent opioid toxicity. Difference-in-differences analysis was used to compare changes in outcomes before and after policy implementation in British Columbia with those in the comparison provinces.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi230090-9\"><jats:title>Results<\/jats:title><jats:p>The Safer Opioid Supply policy was associated with statistically significant increases in rates of opioid prescriptions (2619.6 per 100\u202f000 population; 95% CI, 1322.1-3917.0 per 100\u202f000 population; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001) and claimants (176.4 per 100\u202f000 population; 95% CI, 33.5-319.4 per 100\u202f000 population; <jats:italic>P<\/jats:italic>\u2009=\u2009.02). There was no significant change in prescribers (15.7 per 100\u202f000 population; 95% CI, \u22120.2 to 31.6 per 100\u202f000 population; <jats:italic>P<\/jats:italic>\u2009=\u2009.053). However, the opioid-related poisoning hospitalization rate increased by 3.2 per 100\u202f000 population (95% CI, 0.9-5.6 per 100\u202f000 population; <jats:italic>P<\/jats:italic>\u2009=\u2009.01) after policy implementation. There were no statistically significant changes in deaths from apparent opioid toxicity (1.6 per 100\u202f000 population; 95% CI, \u22121.3 to 4.5 per 100\u202f000 population; <jats:italic>P<\/jats:italic>\u2009=\u2009.26).<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi230090-10\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>Two years after its launch, the Safer Opioid Supply policy in British Columbia was associated with higher rates of safer supply opioid prescribing but also with a significant increase in opioid-related poisoning hospitalizations. These findings will help inform ongoing debates about this policy not only in British Columbia but also in other jurisdictions that are contemplating it.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamainternmed.2023.7570","type":"journal-article","created":{"date-parts":[[2024,1,16]],"date-time":"2024-01-16T16:00:52Z","timestamp":1705420852000},"page":"256","source":"Crossref","is-referenced-by-count":28,"title":["British Columbia\u2019s Safer Opioid Supply Policy and Opioid Outcomes"],"prefix":"10.1001","volume":"184","author":[{"given":"Hai V.","family":"Nguyen","sequence":"first","affiliation":[{"name":"School of Pharmacy, Memorial University, St John\u2019s, Newfoundland and Labrador, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shweta","family":"Mital","sequence":"additional","affiliation":[{"name":"College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shawn","family":"Bugden","sequence":"additional","affiliation":[{"name":"School of Pharmacy, Memorial University, St John\u2019s, Newfoundland and Labrador, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma E.","family":"McGinty","sequence":"additional","affiliation":[{"name":"Weill Cornell Medicine, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"3","key":"ioi230090r2","doi-asserted-by":"publisher","first-page":"484","DOI":"10.17269\/s41997-022-00736-3","article-title":"Public support for safer supply programs: analysis of a cross-sectional survey of Canadians in two provinces.","volume":"114","author":"Morris","year":"2023","journal-title":"Can J Public Health"},{"issue":"5","key":"ioi230090r10","doi-asserted-by":"publisher","first-page":"562","DOI":"10.15288\/jsad.2020.81.562","article-title":"Putting the horse before the unicorn: a safe supply strategy should begin with partial agonists\u2014a commentary on Bonn et al. (2020).","volume":"81","author":"Del Pozo","year":"2020","journal-title":"J Stud Alcohol Drugs"},{"issue":"S2","key":"ioi230090r14","doi-asserted-by":"publisher","first-page":"S151","DOI":"10.2105\/AJPH.2021.306692","article-title":"Implementation of safe supply alternatives during intersecting COVID-19 and overdose health emergencies in British Columbia, Canada, 2021.","volume":"112","author":"McNeil","year":"2022","journal-title":"Am J Public Health"},{"issue":"7","key":"ioi230090r15","doi-asserted-by":"publisher","first-page":"1825","DOI":"10.1111\/dar.v42.7","article-title":"\u201cI don\u2019t chase drugs as much anymore, and I\u2019m not dead\u201d: client reported outcomes associated with safer opioid supply programs in Ontario, Canada.","volume":"42","author":"Schmidt","year":"2023","journal-title":"Drug Alcohol Rev"},{"issue":"1","key":"ioi230090r16","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1186\/s12954-023-00789-8","article-title":"Community partner 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J"},{"issue":"1","key":"ioi230090r31","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1186\/s13011-022-00494-y","article-title":"Moving towards a continuum of safer supply options for people who use drugs: a qualitative study exploring national perspectives on safer supply among professional stakeholders in Canada.","volume":"17","author":"Foreman-Mackey","year":"2022","journal-title":"Subst Abuse Treat Prev Policy"},{"key":"ioi230090r32","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2020.102769","article-title":"Tackling the overdose crisis: the role of safe supply.","volume":"80","author":"Ivsins","year":"2020","journal-title":"Int J Drug Policy"},{"issue":"6","key":"ioi230090r33","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2020-048353","article-title":"Evaluation of risk mitigation measures for people with substance use disorders to address the dual public health crises of COVID-19 and overdose in British Columbia: a mixed-method study 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Joint statement from the co-chairs of the Special Advisory Committee on the Epidemic of Opioid Overdoses\u2014latest national data on substance-related harms. June 26, 2023. Accessed September 16, 2023. https:\/\/www.canada.ca\/en\/public-health\/news\/2023\/06\/joint-statement-from-the-co-chairs-of-the-special-advisory-committee-on-the-epidemic-of-opioid-overdoses--latest-national-data-on-substance-related.html"},{"key":"ioi230090r3","unstructured":"British Columbia Ministry of Health. Access to prescribed safer supply in British Columbia: policy direction. 2021. Accessed February 23, 2022. https:\/\/www2.gov.bc.ca\/assets\/gov\/overdose-awareness\/prescribed_safer_supply_in_bc.pdf"},{"key":"ioi230090r4","unstructured":"British Columbia Centre on Substance Use. Vancouver safe supply program begins prescribing take-home fentanyl. 2022. 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Accessed April 14, 2023. https:\/\/www.canada.ca\/en\/health-canada\/news\/2022\/03\/the-government-of-canada-announces-additional-funding-to-four-safer-supply-pilot-projects.html"},{"key":"ioi230090r8","unstructured":"Healthy Debate. Safer supply prescribing not enough to end devastating opioid epidemic, experts say. February 2, 2022. Accessed February 23, 2022. https:\/\/healthydebate.ca\/2022\/02\/topic\/safer-supply-opioid-epidemic\/"},{"key":"ioi230090r9","unstructured":"Healthy Debate. B.C. expansion to safe supply a start but \u201cstill too little too late.\u201d August 23, 2021. Accessed February 23, 2022. https:\/\/healthydebate.ca\/2021\/08\/topic\/bc-safe-supply-too-little-too-late\/"},{"key":"ioi230090r11","unstructured":"Zimonjic P. Poilievre-backed motion calls for an end to safe drug policies and more cash for treatment. CBC News. May 18, 2023. 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ICD-10 International Statistical Classification of Diseases and Related Health Problems 10th Revision. Volume 2 instruction manual. Fifth ed. 2016. https:\/\/icd.who.int\/browse10\/Content\/statichtml\/ICD10Volume2_en_2019.pdf"},{"key":"ioi230090r27","unstructured":"Bank of Canada. COVID-19 stringency index. 2023. 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