Kolla Gillian, Fajber Kaitlin, Sereda Andrea, Morris Cassidy, Deacon Perri, Cipriano Lauren E
Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada.
Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada.
Drug Alcohol Depend Rep. 2025 Apr 23;15:100338. doi: 10.1016/j.dadr.2025.100338. eCollection 2025 Jun.
Safer opioid supply (SOS) is a harm reduction approach to prescribing pharmaceutical opioids to people at high risk of overdose from the toxic unregulated drug supply. Previous research demonstrates positive health outcomes and reductions in overdose mortality among SOS clients; however few reports describe previous opioid agonist treatment history prior to initiating SOS, or the medication combinations and doses prescribed within SOS programs.
We used convenience sampling to collect survey data from 95 SOS program clients in London, Canada. We use descriptive statistics to analyze survey data and report on OAT history prior to initiating SOS, including maximum methadone dose. We also report on current SOS medication combinations and doses.
Previous experience with OAT was common and reported by 87 % of SOS clients. Mean highest dose of methadone ever received was 95 mg (range: 20-200 mg), with close to 40 % reporting doses of ≥ 120 mg. 95 % of SOS clients reported prescriptions for immediate-release tablet hydromorphone; 28 % were receiving hydromorphone monotherapy; 68 % were receiving hydromorphone alongside a long-acting opioid, and 5 % receiving hydromorphone alongside 2 long-acting opioids. Total average milligram morphine equivalent (MME) doses of combination SOS prescriptions (MME 1616) were similar to high dose methadone (120 mg = MME 1440).
Previous high dose OAT experience was common among SOS clients prior to enrollment in the SOS program. Our results may inform the individualization of high dose opioid prescriptions for people with high tolerance due to exposure to unregulated fentanyl.
更安全的阿片类药物供应（SOS）是一种减少伤害的方法，用于为因无管制的有毒药物供应而面临高过量用药风险的人群开具阿片类药物处方。先前的研究表明，SOS项目参与者的健康状况得到改善，过量用药死亡率降低；然而，很少有报告描述在启动SOS之前参与者先前的阿片类激动剂治疗史，或SOS项目中开具的药物组合和剂量。
我们采用便利抽样的方法，从加拿大伦敦的95名SOS项目参与者中收集调查数据。我们使用描述性统计方法分析调查数据，并报告启动SOS之前的阿片类激动剂治疗史，包括美沙酮最大剂量。我们还报告了当前SOS的药物组合和剂量。
87%的SOS项目参与者报告有过阿片类激动剂治疗史。曾经接受的美沙酮平均最高剂量为95毫克（范围：20 - 200毫克），近40%的参与者报告剂量≥120毫克。95%的SOS项目参与者报告有速释片氢吗啡酮处方；28%接受氢吗啡酮单一疗法；68%在接受氢吗啡酮的同时还接受长效阿片类药物治疗，5%在接受氢吗啡酮的同时还接受两种长效阿片类药物治疗。SOS联合处方的总平均毫克吗啡当量（MME）剂量（MME 1616）与高剂量美沙酮（120毫克 = MME 1440）相似。
在参加SOS项目之前，SOS项目参与者中曾有高剂量阿片类激动剂治疗经历很常见。我们的研究结果可能有助于为因接触无管制芬太尼而耐受性高的人群制定个性化的高剂量阿片类药物处方。
