British Columbia’s “Safer Opioid Supply” Policy Associated With Increased Opioid-related Hospitalizations

In March 2020, British Columbia instituted a “Safer Opioid Supply” policy that allowed prescription of strong oral opioids—and later injectable fentanyl—to persons at high risk of opioid overdose. In this policy analysis, investigators compared population-level changes in opioid-related outcomes from 2016 to 2022 in British Columbia with two Canadian provinces that did not institute the policy (Manitoba and Saskatchewan). Analyses were adjusted for differences in demographics, economic conditions, and COVID-19 public health policies.

• Opioid prescriptions increased by 52 percent after policy implementation in British Columbia, but remained stable in comparison provinces.
• Opioid-related hospitalization trends were similar between British Columbia and comparison provinces before policy implementation, but following implementation British Columbia had a 63 percent relative increase in opioid-related hospitalizations (an increase of 3.2 hospitalizations quarterly per 100,000 population compared with the corresponding increases in the comparison provinces).
• There was no significant association between the policy change and opioid-related deaths, or the number of prescribers.

Comments: Prior smaller studies have demonstrated some benefits for “Safer Opioid Supply” program participants, but this population-level study suggests that increased opioid prescribing may have contributed to disproportionate increases in opioid-related hospitalizations in British Columbia. If prescribed opioids are diverted, the increased prescribing could cause unintended harms. It is also possible that changes in unregulated opioid supplies during the study period were different in British Columbia and other provinces, accounting for the increase in hospitalizations. Additional research is warranted to better understand the risks and benefits of “Safer Opioid Supply” programs.

Aaron D. Fox, MD

Reference: Nguyen HV, Mital S, Bugden S, McGinty EE. British Columbia’s Safer Opioid Supply policy and opioid outcomes. JAMA Intern Med. 2024;184(3):256–264.