London, Ont., study suggests a prescription can change a street drug user's life for the better

A study that followed drug users in London, Ont., who were given prescription opioids instead of using street supplies has found over a third stopped using intravenous drugs.

The findings were released Thursday by the Intercommunity Health Centre. The harm reduction program's year-long study followed 248 people living with addiction on the streets of London between April 1 2020 and Sept. 31, 2021, after researchers received Health Canada funding in March of 2020.

The subjects in the study were given a safe, reliable supply of prescription-grade opioids for free, instead of having to rely on the illicit, expensive and often dangerous supply found on the streets. They also had access to a variety of services at the health centre. 

"We used surveys with people who were starting on the safe supply program for the first time, as well as people who had been on it for more than six months. We also did focus groups with clients, staff and people on the waitlist," said Gillian Kolla, a public health researcher from the University of Victoria who oversaw the London study. 

She highlighted a number of key areas that show the impact of the Safe Opioid Supply Program: 

• One-third of clients stopped using intravenous drugs altogether.
• Overdoses dropped from 59 per cent to 23 per cent in six months.
• Forty-four per cent of clients had not committed a crime to pay for drugs since starting the program.
• Many said relationships with family and friends had improved.

"It seems like safer supply is really having strong impacts on people to develop improved interactions in their community but also to reduce their involvement in criminal activities," Kolla said. 

The findings offer a ray of hope in a province that's seen a surge in opioid-related deaths during the pandemic. In May 2021, Ontario reported 2,050 opioid-related deaths between March and December of 2020, almost double the 1,162 opioid-related deaths in the same time period in 2019.

Program born out of 'desperation'

Overdose deaths are something Dr. Andrea Sereda is all too familiar with, and it's why she and her team developed the Safer Opioid Supply Program in the first place in 2016. It's the same year London handed out some 2.5 million needles, making it second only to Vancouver when it came to publicly funded needle use in Canada.

Sereda said fentanyl had been on London streets for a few years by then, and health-care workers were dealing with a steady wave of overdoses, infectious complications from regular needle use and were hearing plenty of stories about the desperate acts some drug users had to carry out in order to afford their daily fixes.

"Conventional intervention was really not working against fentanyl, so we knew we had to do something different," she said. 

Instead of focusing on trying to get people struggling with addictions to abstain from drug use, the InterCommunity Health Centre started to focus on reducing risks, starting with the drug supply. 

Sereda said what most people overlook about fentanyl addiction and, in many cases fail to understand about the people who have struggled with it, is that the drug itself is unlike any other opioid.

Unlike heroin, where users might dose two to four times a day, fentanyl is very quick, she said. Because its effects dissipate so quickly, users may have to inject it every hour and even then, longtime users aren't even be taking it to get high, she said.

With safe, reliable supply, users' lives came into focus

"What people are really doing is not to experience feeling dope sick day in and day out," said Sereda.

"Your day revolves around just not being sick and you can imagine, if you're having to dose and find drugs that frequently during the day, it's really hard to accomplish anything else —for example, looking for housing, coming to your doctor for chronic medical concerns, being safe day to day."

Sereda said what outreach workers and clinicians found in those early days is that when they gave drug users a prescription for a safe reliable supply of opioids, their world suddenly came into focus.

"We've seen people becoming housed. We see people staying out of the emergency room. It gives people this breathing room to sort of focus on all the other things they have to accomplish." 

Sereda said she hopes the results will help expand harm reduction treatments in London and allow other communities to create their own version, tailored to their individual community needs.