Depict a somber Canadian city hospital emergency room at the height of the opioid and stimulant crisis, flooded with doctors and nurses attending to overdose patients. The scene should convey an overwhelming sense of urgency, desperation, and hope amid chaos. Use muted, cold colors to represent the stark reality, but with subtle hints of warmth to suggest the presence of hope through community care and medical attention. The image should balance realism with emotional gravity.
During dual public health crises, the opioid epidemic and the COVID-19 pandemic, British Columbia implemented Risk Mitigation Guidance (RMG) to address rising overdose deaths. This population-based cohort study explored the effectiveness of RMG on opioid and stimulant prescriptions.
The research included 5882 participants with opioid or stimulant use disorders who received RMG prescriptions between March 2020 and August 2021. The participants were matched with control groups through high-dimensional propensity score matching to analyze outcomes related to mortality and acute care visits.
Lead researcher Dr. Amanda Slaunwhite commented, “The findings highlight the importance of pharmaceutical alternatives to the illegal drug supply, particularly for those struggling with opioid use disorders.” The study revealed that opioid RMG prescriptions of at least one day significantly reduced all-cause and overdose-related mortality. When dispensed for four or more days, the reduction in mortality was even more pronounced. Participants who received opioid RMG for four or more days showed a 91% decrease in all-cause mortality compared to controls.
However, stimulant RMG did not show a statistically significant reduction in mortality. “Although opioid RMG demonstrated clear benefits, stimulant RMG did not have a notable impact on reducing deaths,” noted Dr. Jeong Eun Min, co-author of the study. Nevertheless, stimulant RMG was associated with a reduction in acute care visits, highlighting its potential to reduce healthcare strain.
The public health emergency in British Columbia due to the fentanyl-laced illicit drug supply made these interventions vital. Pharmaceutical alternatives, such as those offered under RMG, aim to reduce reliance on the dangerous street drug market. “Our results support the expansion of RMG as a harm reduction tool in the context of the opioid crisis,” said Dr. Bernie Pauly, another study co-author.
This research underscores the urgent need for further harm reduction interventions, particularly for individuals at high risk of overdose. Policies aimed at mitigating risks from unregulated drug use continue to evolve as the overdose crisis persists. The authors stress the need for ongoing research to determine the broader impact of RMG in reducing healthcare visits and mortality.
While the study focused on British Columbia, the findings are relevant for other regions grappling with the opioid epidemic. “We hope these results encourage policymakers to adopt similar measures in their efforts to combat opioid-related harm,” concluded Dr. Bohdan Nosyk.
As the global opioid crisis worsens, innovative approaches such as RMG offer hope. RMG opioids reduced both overdose and all-cause mortality, particularly with longer prescription durations, providing a pathway for safer drug consumption.
Citation:
Slaunwhite A, Min JE, Palis H, Urbanoski K, Pauly B, Barker B, et al. Effect of Risk Mitigation Guidance for opioid and stimulant dispensations on mortality and acute care visits during dual public health emergencies: retrospective cohort study. BMJ. 2024;384. doi:10.1136/bmj-2023-076336
License:
This content is generated from the original article original article and it’s under Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.
