Theme: Epidemiology & Public Health Research Year: 2024
Background: Despite measures implemented to address the opioid crisis, including the provision of hydromorphone as part of a safer supply program, concerns have arisen regarding its potential misuse. We prospectively evaluated the pattern of prescribed hydromorphone use among individuals in our multidisciplinary clinic receiving prescribed safer supplies including those who live with HIV.
Methods: 03-04/2024, 50 individuals with an active prescription for hydromorphone were recruited. A urine sample was collected and tested for hydromorphone, cocaine, amphetamines, fentanyl, and methadone. A demographic and behavioral questionnaire was completed elucidating their hydromorphone usage patterns. The questionnaire was administered in a linked but anonymous manner separately from the process of prescription renewal.
Results: To date, 50 individuals have been enrolled: median age of 49(21-69) years, 26% indigenous, 82% unstably housed, 92% unemployed, 84% previously incarcerated, 58% with recent overdose events, 10% HIV infection and 74% HCV infection. All had been prescribed hydromorphone at VIDC (average of 15 months) at a median daily dose of 112 mg. The results of urine drug screens indicate polysubstance street drug use in all participants, with predominate use of fentanyl (84%) and amphetamines (72%). Hydromorphone was detected in 38/50 samples. According to the questionnaire, 62% were taking the hydromorphone as prescribed, some were either smoking/injecting some of the prescribed quantity (14%), others were selling/trading a proportion of their hydromorphone (20%). 2 participants stated they sold/traded all the prescription. Of 50 individuals receiving safer supply over the past year, there have been no overdose-related deaths.
Conclusion: The provision of safer supply has not led to discontinuation of reliance on street drug supply but appears to have had a benefit on opioid-related mortality. If safer supply continues to be used as a tool to address the opioid crisis, there is a need to monitor individuals to understand to maximize the benefit of this intervention.