Gomes Tara, McCormack Daniel, Kolla Gillian, Young Samantha, Bayoumi Ahmed M, Smoke Ashley, Li Ping, Antoniou Tony
ICES, Toronto, ON, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada; MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, ON, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
ICES, Toronto, ON, Canada.
Lancet Public Health. 2025 May;10(5):e412-e421. doi: 10.1016/S2468-2667(25)00070-2. Epub 2025 Apr 22.
Prescribed safer opioid supply (SOS) programmes are novel harm reduction interventions. We examined health outcomes among people receiving SOS over time and relative to a similar group of people receiving methadone.
We conducted a population-based cohort study among new SOS and methadone recipients in Ontario, Canada, who commenced treatment between Jan 1, 2016 and Dec 31, 2021. People receiving SOS were matched (1:1) to new methadone recipients based on age (within 3 years), sex, location of residence (public health unit), and propensity score (within 0·2 SDs). Primary outcomes were hospital-treated opioid-related toxicities, emergency department visits and inpatient hospitalisations, incident infections, and health-care costs (in CA$, excluding costs related to primary care services and medications) over 1 year of follow-up. Outcome rates were calculated over the follow-up period, with censoring on death, discontinuation of SOS or methadone, or end of follow-up (360 days). Within-group changes in outcomes were assessed using interrupted time-series analysis, and Prentice-Williams-Peterson regression was used to assess between-group differences in recurrent events.
Of the 991 new recipients prescribed SOS and 25 116 new methadone recipients who met the eligibility criteria, 856 (86·4%) people receiving SOS were matched to 856 people receiving methadone. In the within-group analysis, matched SOS recipients had significant improvements in the monthly rate of opioid toxicities (step change -1·09 events per 100 individuals [95% CI -2·12 to -0·07]; p=0·037), all-cause emergency department visits (-8·85 per person-year [-13·5 to -4·20]; p=0·0002), all-cause inpatient hospitalisations (-2·08 per person-year [-3·41 to -0·75]; p=0·0022), incident infections (-0·68 per person-year [-1·22 to -0·14]; p=0·013), and non-primary-care-related health-care costs (-$91 699 per person-year [-112 749 to -70 650]; p<0·0001). Results were consistent for methadone recipients. In the between-group analysis, individuals commencing SOS had significantly higher hazards of opioid toxicity (hazard ratio 2·83 [95% CI 1·97 to 4·06]), emergency department visits (1·16 [1·05 to 1·29]), and inpatient admissions (1·50 [1·13 to 1·99]), no significant difference in the rate of incident infection (1·51 [0·87 to 2·61]), and were less likely to discontinue treatment than those commencing methadone (0·62 [0·55 to 0·70]). When treatment discontinuation was removed as a censoring criterion, we found no difference between groups in the hazard of any of the primary outcomes except opioid toxicity (1·65 [1·38 to 1·97]).
SOS and methadone were associated with improvements in health outcomes, including reduced opioid toxicities and health-care use, in the year after treatment initiation. The findings suggest SOS programmes play an important, complementary role to traditional opioid agonist treatment in expanding the options available to support people who use drugs.
Canadian Institutes of Health Research and Ontario SPOR Support Unit.
规定的更安全阿片类药物供应（SOS）计划是新型的减少伤害干预措施。我们研究了接受SOS治疗的人群随时间推移的健康结果，并与一组接受美沙酮治疗的类似人群进行了比较。
我们在加拿大安大略省新接受SOS治疗和美沙酮治疗的人群中开展了一项基于人群的队列研究，这些人于2016年1月1日至2021年12月31日开始治疗。接受SOS治疗的人与新接受美沙酮治疗的人根据年龄（3年内）、性别、居住地点（公共卫生单位）和倾向得分（0.2个标准差内）进行1:1匹配。主要结局包括随访1年期间医院治疗的阿片类药物相关毒性、急诊就诊和住院、新发感染以及医疗费用（以加元计，不包括与初级保健服务和药物相关的费用）。在随访期内计算结局发生率，以死亡、停止SOS或美沙酮治疗或随访结束（360天）进行删失。使用中断时间序列分析评估组内结局变化，并使用Prentice-Williams-Peterson回归评估复发事件的组间差异。
在991名新接受SOS治疗的人和25116名符合资格标准的新接受美沙酮治疗的人中，856名（86.4%）接受SOS治疗的人与856名接受美沙酮治疗的人匹配。在组内分析中，匹配的接受SOS治疗者在阿片类药物毒性月发生率（阶跃变化为每100人-1.09次事件[95%CI -2.12至-0.07]；p=0.037）、全因急诊就诊（每人年-8.85次[-13.5至-4.20]；p=0.0002）、全因住院（每人年-2.08次[-3.41至-0.75]；p=0.0022）、新发感染（每人年-0.68次[-1.22至-0.14]；p=0.013）以及非初级保健相关医疗费用（每人年-91699加元[-112749至-70650]；p<0.0001）方面有显著改善。美沙酮接受者的结果一致。在组间分析中，开始接受SOS治疗的个体发生阿片类药物毒性（风险比2.83[95%CI 1.97至4.06]）、急诊就诊（1.16[1.05至1.29]）和住院（1.50[1.13至1.99]）的风险显著更高，新发感染率无显著差异（1.51[0.
