Effect of Risk Mitigation Guidance opioid and stimulant dispensations on mortality and acute care visits during dual public health emergencies: retrospective cohort study

SPS commentary:

The researchers note the first iteration of RMG was issued in British Columbia in 2020, providing clinical guidance about prescribing select medications to people at risk of SARS-Cov-2 infection in the interest of reducing harm from exposure to the illegal drug supply. This practice is commonly known as “prescribed safer supply.” The RMG was initially focused on supporting people experiencing withdrawal due to public health quarantine and isolation protocols. In 2021, British Columbia released a provincial Prescribed Safer Supply policy that extended prescribing outside the covid-19 pandemic.

According to an editorial, current supply reduction policies may be driving proliferation of potent synthetic drugs, manufactured inexpensively without relying on illicit crops. It notes the current policy responses have failed to reduce global drug use, harms, or supply, as numbers of deaths and healthy life years lost attributable to drugs have roughly doubled since 1990. It suggests models of safer supply could offer an alternative avenue to reduce harms from a rapidly evolving and increasingly toxic drug market. It adds that proponents of safer supply face challenges, such as stigma, which has historically limited support from the public and policy makers for innovative harm reduction interventions. It concludes that the evidence for safer supply is not perfect, but in countries where deaths are escalating due to toxic unregulated drug supplies, governments need to take urgent action, which requires taking calculated risks in collaboration with affected populations and investing in safer supply interventions supported by a growing observational evidence base.