{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T07:22:46Z","timestamp":1777015366888,"version":"3.51.4"},"reference-count":37,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2023,12,19]],"date-time":"2023-12-19T00:00:00Z","timestamp":1702944000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["448935"],"award-info":[{"award-number":["448935"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Ontario Ministry of Health","award":["709"],"award-info":[{"award-number":["709"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Aims<\/jats:title>\n<jats:p>Calls to prescribe safer supply hydromorphone (SSHM) as an alternative to the toxic drug supply increased during the COVID-19 pandemic but it is unknown whether prescribing behaviour was altered. We aimed to evaluate how the number of new SSHM dispensations changed during the pandemic in Ontario.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We conducted a retrospective interrupted time-series analysis using provincial administrative databases. We counted new SSHM dispensations in successive 28-day periods from March 22, 2016 to August 30, 2021. We used segmented Poisson regression methods to test for both a change in level and trend of new dispensations before and after March 17, 2020, the date Ontario\u2019s pandemic-related emergency was declared. We adjusted the models to account for seasonality and assessed for over-dispersion and residual autocorrelation. We used counterfactual analysis methods to estimate the number of new dispensations attributable to the pandemic.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>We identified 1489 new SSHM dispensations during the study period (434 [mean of 8 per 28-day period] before and 1055 [mean of 56 per 28-day period] during the pandemic). Median age of individuals initiating SSHM was 40 (interquartile interval 33\u201348) with 61.7% (N = 919) male sex. Before the pandemic, there was a small trend of increased prescribing (incidence rate ratio [IRR] per period 1.002; 95% confidence interval [95CI] 1.001\u20131.002; p&lt;0.001), with a change in level (immediate increase) at the pandemic date (relative increase in IRR 1.674; 95CI 1.206\u20132.322; p = 0.002). The trend during the pandemic was not statistically significant (relative increase in IRR 1.000; 95CI 1.000\u20131.001; p = 0.251). We estimated 511 (95CI 327\u2013695) new dispensations would not have occurred without the pandemic.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>The pandemic led to an abrupt increase in SSHM prescribing in Ontario, although the rate of increase was similar before and during the pandemic. The absolute number of individuals who accessed SSHM remained low throughout the pandemic.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0295145","type":"journal-article","created":{"date-parts":[[2023,12,19]],"date-time":"2023-12-19T18:25:23Z","timestamp":1703010323000},"page":"e0295145","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":9,"title":["Initiations of safer supply hydromorphone increased during the COVID-19 pandemic in Ontario: An interrupted time series analysis"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4064-0884","authenticated-orcid":true,"given":"Samantha","family":"Young","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tara","family":"Gomes","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gillian","family":"Kolla","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"McCormack","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zo\u00eb","family":"Dodd","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janet","family":"Raboud","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmed M.","family":"Bayoumi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2023,12,19]]},"reference":[{"key":"pone.0295145.ref001","unstructured":"Government of Canada. Opioid- and Stimulant-related Harms in Canada 2022 [cited 2023 25 May]. Available from: https:\/\/health-infobase.canada.ca\/substance-related-harms\/opioids-stimulants\/."},{"key":"pone.0295145.ref002","volume-title":"Provisional drug overdose death counts","author":"FB Ahmad","year":"2023"},{"key":"pone.0295145.ref003","unstructured":"Canadian Association of People Who Use Drugs. SAFE SUPPLY: Concept Document. 2019."},{"key":"pone.0295145.ref004","volume-title":"Urgent call on clinicians: Prescribe alternatives to poisoned drug supply:","author":"N Rai","year":"2019"},{"key":"pone.0295145.ref005","article-title":"Do we use laws, diversions or safer supply to end toxic drug deaths? All of the above, and more","author":"J Altenberg","year":"2023","journal-title":"The Globe and Mail [Internet]."},{"issue":"4","key":"pone.0295145.ref006","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1097\/ADM.0000000000000928","article-title":"Trends in Hospitalizations for Serious Infections Among People With Opioid Use Disorder in Ontario, Canada.","volume":"16","author":"T Gomes","year":"2022","journal-title":"J Addict Med."},{"key":"pone.0295145.ref007","doi-asserted-by":"crossref","first-page":"103601","DOI":"10.1016\/j.drugpo.2022.103601","article-title":"Characterizing safer supply prescribing of immediate release hydromorphone for individuals with opioid use disorder across Ontario, Canada.","volume":"102","author":"S Young","year":"2022","journal-title":"Int J Drug Policy"},{"issue":"1","key":"pone.0295145.ref008","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1186\/s13011-021-00423-5","article-title":"The impact of the novel coronavirus disease (COVID-19) pandemic on drug overdose-related deaths in the United States and Canada: a systematic review of observational studies and analysis of public health surveillance data.","volume":"16","author":"S Imtiaz","year":"2021","journal-title":"Subst Abuse Treat Prev Policy"},{"key":"pone.0295145.ref009","volume-title":"Preliminary Patterns in Circumstances Surrounding Opioid-Related Deaths in Ontario during the COVID-19 Pandemic","author":"Ontario Drug Policy Research Network, Office of the Chief Coroner for Ontario\/Ontario Forensic Pathology Service, Ontario Agency for Health Protection and Promotion (Public Health Ontario), Evaluation CoDP","year":"2020"},{"key":"pone.0295145.ref010","unstructured":"Government of Canada helping expand access to safer supply across Canada [Internet]. 2021; June 28. 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