Automated opioid delivery has reduced drug-related harms

A British Columbia program using biometric dispensers to supply pharmaceutical-grade opioids to patients with opioid use disorder has reduced drug-related harms and could potentially overcome barriers to other safer delivery strategies, an analysis found .

Features that encouraged use of the biometric delivery platform included accessibility and choice of participants, lack of consequences for missed doses, unwitnessed dosing, lack of judgment, and ability to stack doses. Barriers included technical issues with the dispenser, dosing issues, and prescriptions tied to individual machines.

Geoff Bardwell, PhD

“What is at stake here is providing more autonomy, accessibility and really just flexibility with drug dosing and how drugs are delivered, compared to other programs not just other safer opioid delivery programs in Canada, but also thinking about treatments like methadone or buprenorphine,” said lead researcher Geoff Bardwell, PhD, research scientist at the British Columbia Center on Substance Use (BCCSU) and assistant professor in the University\’s School of Public Health Sciences of Waterloo, Waterloo, Ontario, Canada Medscape Medical News.

The study was published May 15 in Journal of the Canadian Medical Association.

Opioid deaths have increased

As in the United States, opioid-related deaths in Canada have increased in recent years. According to data from the Public Health Agency of Canada, annual deaths from opioid toxicity have doubled since 2019. While the number of deaths in the first 9 months of 2022 (the latest period for which the agency has data) is lower by about 8% over the same period in 2021, it is still double the prepandemic rate.

In response, the Canadian federal government has provided funding for Safer Supply pilot programs. A study from last year in the International journal of drug policy reported that the number of safer procurement sites in Canada increased by 285% between March and May 2020 in response to the COVID-19 pandemic.

Typically, safer delivery programs require participants to be at a specific location, such as a clinic or treatment center, at a specific time to get their doses and meet staff. “This process can be really shameful and stigmatizing and lacks privacy,” Bardwell said.

The MySafe program placed biometric machines in two support housing in Vancouver and one in Victoria which allowed participants to access doses at their convenience without any interaction with staff. Another car was placed at an overdose prevention site in Vancouver.

A local pharmacy dispenses the medications, and MySafe staff manually load the prescribed doses, in the form of packaged daily doses of tablets, into the machines. A participant accesses a dose by scanning his or her handprint and the machine dispenses it. Participants are required to take their medications every day. They have medical evaluations at enrollment and at 1, 6, and 12 months.

\”If you think you have to go somewhere every single day to get your medications, maybe that\’s something you can do, but on top of that, add these real-world consequences like being identified as someone taking a particular medication,\” she said Bardwell. . \”When we think about the MySafe program, yes, there is discovery related to access to this particular drug, but I think it has merit in terms of how we might think about the delivery of other drugs.\”

Decreased risk of overdose

The qualitative study used a questionnaire that the researchers developed with input from a community advisory board made up of clinical staff and people with a history of drug use. The researchers conducted one-on-one interviews with 46 MySafe program participants from November 2021 to April 2022.

MySafe participants reported using fewer illicit drugs, having a lower risk of overdose, and a better sense of health and well-being since enrolling in the program. They also reported a positive financial impact.

The study also found barriers to accessing the program. Almost all of the participants experienced technical problems with the machines, which sometimes led them to go into withdrawal or buy drugs illegally. Sometimes their medications did not match the current strength of illicit opioids. About a third of participants were concerned that their prescriptions were tied to a specific machine. If they were registered to a machine in their supportive housing building, they could not be registered to the machine at the overdose treatment site and vice versa.

Qualitative design is a strength of the studio, Bardwell said. \”Because this is a qualitative study, we were able to do a deep dive into particular experiences, which are obvious limitations to quantitative studies,\” she said. Another strength was \”working with a community advisory board to make sure we were asking the right questions.\”

The study is part of a larger longitudinal, mixed-methods evaluation of the MySafe program, Bardwell said.

\”Required\” qualitative studies

Commenting on the study for MedscapeRebecca Saah, PhD, associate professor at the University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada, said the expansion of safer supply programs has been \”particularly controversial and weaponized by various federal politicians and locals\”. Saah did not participate in the research.

\”This study is really needed,\” Saah said. “This type of research that engages very deeply and meaningfully with a very hard-to-reach marginalized population takes a huge amount of effort to do well. They really engaged deeply with the population and got a high degree of diverse and honest responses. .\”

Saah refuted criticisms of the study\’s qualitative methodology. \”I\’m a qualitative methodologist, teaching qualitative methodology to physicians and surgeons at our medical school here, and I think qualitative research is absolutely necessary when evaluating a new intervention for a specific population, especially a marginalized population.\”

The study was funded by Health Canadas Substance Use and Addictions Program. Bardwell and Saah report no material financial relationships.

CMJ extension. Published May 15, 2023. Full text.

Richard Mark Kirkner is a medical journalist based in the Philadelphia area.

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