This award is co-funded by Health Research BC, through CIHR’s Operating Grant: COVID-19 Rapid Research Funding Opportunity – Social Policy and Public Health Responses.
A team led by Dr. Amanda Slaunwhite, Senior Scientist with the BC Centre for Disease Control and an adjunct professor in the School of Population and Public Health will assess the impact of the new risk-mitigation guidance that permits prescribing of pharmaceutical alternatives to the toxic drug supply. Researchers will determine the effects of the pandemic and risk mitigation measures on COVID-19 infection, continuity of care for treatment of substance use disorders and non-fatal and fatal overdose in BC. The researchers will also identify barriers and facilitators to implementation from the perspectives of people who use substances, prescribers, harm reduction workers, and other providers and community members.
The team is led by principal investigators at UBC, the Canadian Institute for Substance Use Research (CISUR) at the University of Victoria (Dr. Bernie Pauly and Dr. Karen Urbanoski) and Simon Fraser University (Dr. Bohdan Nosyk and Dr. Natt Hongdilokkul). The team includes co-investigators and collaborators from the First Nations Health Authority, Ministry of Mental Health and Addictions, BC Centre on Substance Use, the BCCDC-based Compassion Inclusion and Engagement (CIE) (PEEP) peer network, Provincial Health Services Authority, BC-Yukon Association of Drug War Survivors and Public Health Agency of Canada.
End of Award Update – August 2023
Most exciting outputs so far
Briefly, our research activities to date suggest that prescribed safer supply has many benefits to persons who receive medications, however implementation and access was uneven across the province. Prescribed safer supply opioids have reached approximately 7,000 persons since March 2020 and indications from preliminary administrative health data suggest that the intervention may protect against mortality. Participants who received safer supply reported many positive benefits, however access to these medications is very limited due to limited prescribers.
The project is concluding over the next few months as we transition into a new CIHR-funded longer-term evaluation project. As of June 2022, we have pivoted from data collection and analysis to knowledge translation activities including the development of peer reviewed manuscripts. There are over 10 manuscripts under development.
We have published the study protocol in BMJ Open. We have also publicly posted Knowledge Updates and Infographics about emerging results on the BCCDC website. These results have also been disseminated through the BC Overdose Emergency Response Centre list-serv. Some examples are:
- Risk Mitigation Guidance (RMG) evaluation findings (BCCDC, March 27 2020 – December 31 2021)
- Knowledge Update: Post-mortem detection of hydromorphone among persons identified as having an illicit drug toxicity death since the introduction of Risk Mitigation Guidance prescribing: Toxicology supplement (BCCDC, December 2021)
- Knowledge Update: Post-mortem detection of hydromorphone among persons identified as having an illicit drug toxicity death since the introduction of Risk Mitigation Guidance prescribing (BCCDC, September 2021)
Knowledge translation has been ongoing since the project began. Our knowledge translation efforts are co-led by persons with lived experience who have been heavily engaged in the project. There has been international and national interest in this project and we have been invited to present to many audiences including the New Zealand Drug Foundation:
Impacts so far
This project has had a direct impact on the Province of BC’s prescribed safer supply policy directive and program implementation strategies. The results of this project are cited in several policy and clinical guidance documents including:
- B.C. introduces new prescribed safer supply policy, a Canadian first (BC Government News Release, July 2021)
- Opioid Use Disorder Practice Update (BC Centre on Substance Use, February 2022)
Potential Influence
This project has had a significance influence on our future research activities by providing an opportunity for researchers from UVic, SFU and UBC to partner with persons with lived experience, the First Nations Health Authority and other health system partners to work together to better understand prescribed safer supply in BC. These partnerships have led to many new successful grants from CIHR, Providence Health Care, Health Canada and the Office of the Representative for Children and Youth.
Next Steps
We have several new grants, including awards from CIHR and Health Canada, that have been funded in the past six months to continue our work in this area. This includes three projects:
- Mathematical Modeling Prescribed Safer Supply (NPI: Nosyk) – Funded by CIHR, 2021-2024
- Evaluating prescribed safer supply among formerly incarcerated persons during an overdose public health emergency (NPI: Slaunwhite)- Funded by SUAP Health Canada, 2022-2023
- A mixed methods evaluation of safer supply initiatives to reduce illicit drug overdose in BC (NPI: Urbanoski) – Funded by CIHR, 2022-2026