Nguyen Hai V, Mital Shweta, Bugden Shawn, McGinty Emma E
School of Pharmacy, Memorial University, St John's, Newfoundland and Labrador, Canada.
College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada.
JAMA Intern Med. 2024 Mar 1;184(3):256-264. doi: 10.1001/jamainternmed.2023.7570.
In March 2020, British Columbia, Canada, became the first jurisdiction globally to launch a large-scale provincewide safer supply policy. The policy allowed individuals with opioid use disorder at high risk of overdose or poisoning to receive pharmaceutical-grade opioids prescribed by a physician or nurse practitioner, but to date, opioid-related outcomes after policy implementation have not been explored.
To investigate the association of British Columbia's Safer Opioid Supply policy with opioid prescribing and opioid-related health outcomes.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study used quarterly province-level data from quarter 1 of 2016 (January 1, 2016) to quarter 1 of 2022 (March 31, 2022), from British Columbia, where the Safer Opioid Supply policy was implemented, and Manitoba and Saskatchewan, where the policy was not implemented (comparison provinces).
Safer Opioid Supply policy implemented in British Columbia in March 2020.
The main outcomes were rates of prescriptions, claimants, and prescribers of opioids targeted by the Safer Opioid Supply policy (hydromorphone, morphine, oxycodone, and fentanyl); opioid-related poisoning hospitalizations; and deaths from apparent opioid toxicity. Difference-in-differences analysis was used to compare changes in outcomes before and after policy implementation in British Columbia with those in the comparison provinces.
The Safer Opioid Supply policy was associated with statistically significant increases in rates of opioid prescriptions (2619.6 per 100 000 population; 95% CI, 1322.1-3917.0 per 100 000 population; P < .001) and claimants (176.4 per 100 000 population; 95% CI, 33.5-319.4 per 100 000 population; P = .02). There was no significant change in prescribers (15.7 per 100 000 population; 95% CI, -0.2 to 31.6 per 100 000 population; P = .053). However, the opioid-related poisoning hospitalization rate increased by 3.2 per 100 000 population (95% CI, 0.9-5.6 per 100 000 population; P = .01) after policy implementation. There were no statistically significant changes in deaths from apparent opioid toxicity (1.6 per 100 000 population; 95% CI, -1.3 to 4.5 per 100 000 population; P = .26).
Two years after its launch, the Safer Opioid Supply policy in British Columbia was associated with higher rates of safer supply opioid prescribing but also with a significant increase in opioid-related poisoning hospitalizations. These findings will help inform ongoing debates about this policy not only in British Columbia but also in other jurisdictions that are contemplating it.
2020年3月，加拿大不列颠哥伦比亚省成为全球首个在全省范围内推行大规模更安全供应政策的司法管辖区。该政策允许有药物过量或中毒高风险的阿片类药物使用障碍患者接受医生或执业护士开具的药用级阿片类药物，但迄今为止，尚未对政策实施后的阿片类药物相关结果进行探讨。
调查不列颠哥伦比亚省更安全阿片类药物供应政策与阿片类药物处方及阿片类药物相关健康结果之间的关联。
设计、背景和参与者：这项队列研究使用了2016年第1季度（2016年1月1日）至2022年第1季度（2022年3月31日）不列颠哥伦比亚省的省级季度数据，该省实施了更安全阿片类药物供应政策，以及未实施该政策的马尼托巴省和萨斯喀彻温省（对照省份）。
2020年3月在不列颠哥伦比亚省实施的更安全阿片类药物供应政策。
主要结局为更安全阿片类药物供应政策所针对的阿片类药物（氢吗啡酮、吗啡、羟考酮和芬太尼）的处方率、申领者和开处方者；阿片类药物相关中毒住院率；以及明显阿片类药物中毒导致的死亡。采用差分分析来比较不列颠哥伦比亚省政策实施前后与对照省份结局的变化。
更安全阿片类药物供应政策与阿片类药物处方率（每10万人口2619.6例；95%置信区间，每10万人口1322.1 - 3917.0例；P < 0.001）和申领者（每10万人口176.4例；95%置信区间，每10万人口33.5 - 319.4例；P = 0.02）的统计学显著增加相关。开处方者无显著变化（每10万人口15.7例；95%置信区间，每10万人口 - 0.2至31.6例；P = 0.053）。然而，政策实施后，阿片类药物相关中毒住院率每10万人口增加了3.2例（95%置信区间，每10万人口0.9 - 5.6例；P = 0.01）。明显阿片类药物中毒导致的死亡无统计学显著变化（每10万人口1.6例；95%置信区间，每10万人口 - 1.3至4.5例；P = 0.26）。
不列颠哥伦比亚省的更安全阿片类药物供应政策在实施两年后，与更安全供应阿片类药物的更高处方率相关，但也与阿片类药物相关中毒住院率的显著增加相关。这些发现将有助于为不列颠哥伦比亚省以及其他正在考虑该政策的司法管辖区正在进行的关于该政策的辩论提供信息。
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