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Searching for a Drug Strategy:
Seeking a response to substance-related harms
and the overdose crisis May 2024
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Dr. Paxton Bach
Co-Medical Director, British Columbia Centre on Substance Use
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Paxton Bach MD, MSc, ABIM, FRCPC, FASAM is a Clinical Assistant Professor in the Department of Medicine at the University of British Columbia and a general internist and addiction medicine physician at St. Paul’s Hospital in Vancouver, BC. He additionally serves as the Co-Medical Director for the British Columbia Centre on Substance Use, the Director of the BCCSU Clinical Addiction Medicine Fellowship Program, and is a clinician-scientist with the BCCSU. His research interests include overdose prevention, as well as the development of evidence-based treatment for opioid and stimulant use disorders. He is supported by a Health Professional-Investigator Award from Michael Smith Health Research BC.
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On May 30, 2024, a town hall meeting was held to address the escalating opioid crisis and discuss comprehensive strategies involving prevention, treatment, harm reduction, and enforcement. The event featured several distinguished speakers who provided insights based on their expertise and experiences in various aspects of drug policy and public health.
Dr. Paxton Bach discussed opioid agonist treatment (OAT) and its role in managing opioid use disorder. He emphasized the need for a comprehensive response to the overdose crisis, including safer supply as an additional tool in the treatment arsenal. Bach highlighted the importance of individualized treatment approaches and the need to combat stigma to prevent individuals from using drugs alone. This town hall underscored the complexity of the opioid crisis and the necessity of a multifaceted approach involving prevention, harm reduction, treatment, and enforcement. The speakers collectively advocated for evidence-based strategies, comprehensive care, and collaborative efforts to effectively address the crisis and support affected individuals and communities. |
Guest Speakers: |
Presentation
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View presentation slides
Opioid Agonist Treatment & Safer Supply
- OAT as Gold Standard: Opioid agonist treatment, including methadone and Suboxone, is the gold standard for treating opioid use disorder.
- Safer Supply Effectiveness: Evidence indicates that safer supply can reduce overdose deaths and improve quality of life, though further research is needed.
- Comprehensive Approach: A multi-faceted approach, including safer supply, is essential to address the complex and evolving overdose crisis.
Dr. Paxton Bach discusses opioid agonist treatment (OAT), highlighting its role as the gold standard for treating opioid use disorder. OAT includes medications like methadone, Suboxone, and slow-release morphine, which are crucial for preventing deaths among those with opioid use disorder. Bach emphasizes the complexity of the overdose crisis, describing it as a "wicked problem" composed of various evolving and context-specific issues. He stresses the need for comprehensive and localized responses tailored to specific community needs.
Bach acknowledges the importance of a multi-faceted approach, including safer supply, which provides prescribed medications as safer alternatives to the toxic illegal drug supply. Safer supply aims to reduce overdose deaths and other harms associated with unregulated street drugs. The program primarily involves prescribing hydromorphone, a specific opioid, and is currently implemented in a prescriber-based model in British Columbia (BC). Bach discusses two key questions regarding safer supply: its effectiveness in reducing overdose deaths and the potential unintended consequences.
Evidence suggests that safer supply can be effective. A review of 20 publications, including peer-reviewed studies and program evaluations, indicates a possible decrease in fatal opioid toxicity events and improvements in physical and mental health among participants. Two studies from BC report a 91% decreased risk of all-cause mortality and increased likelihood of accessing OAT among those receiving safer supply medications.
However, Bach highlights the need for further research on the long-term effects and potential harms of safer supply programs. While there have been reports of increased addiction rates and opioid-related hospitalizations, surveillance data do not show clear evidence of these issues. Diversion of prescribed medications, such as hydromorphone, into the illicit market is a concern, but it remains a minor part of overall opioid trafficking.
From a clinical perspective, Bach views safer supply as an additional tool in the treatment arsenal. While methadone and Suboxone are highly effective for many patients, safer supply can help those for whom these treatments are not suitable. Hydromorphone provides a predictable alternative to the unpredictable street drug supply, helping to stabilize patients and prevent overdoses. Bach stresses the importance of individualized treatment approaches, recognizing that different patients have different needs and goals.
Bach also addresses the terminology shift from "drug overdose" to "drug poisoning," reflecting the reality that many deaths are due to the unpredictable and contaminated drug supply rather than solely addiction. He emphasizes the need to combat stigma and ensure that individuals do not have to use drugs alone, as this increases the risk of fatal overdoses.
Bach acknowledges the importance of a multi-faceted approach, including safer supply, which provides prescribed medications as safer alternatives to the toxic illegal drug supply. Safer supply aims to reduce overdose deaths and other harms associated with unregulated street drugs. The program primarily involves prescribing hydromorphone, a specific opioid, and is currently implemented in a prescriber-based model in British Columbia (BC). Bach discusses two key questions regarding safer supply: its effectiveness in reducing overdose deaths and the potential unintended consequences.
Evidence suggests that safer supply can be effective. A review of 20 publications, including peer-reviewed studies and program evaluations, indicates a possible decrease in fatal opioid toxicity events and improvements in physical and mental health among participants. Two studies from BC report a 91% decreased risk of all-cause mortality and increased likelihood of accessing OAT among those receiving safer supply medications.
However, Bach highlights the need for further research on the long-term effects and potential harms of safer supply programs. While there have been reports of increased addiction rates and opioid-related hospitalizations, surveillance data do not show clear evidence of these issues. Diversion of prescribed medications, such as hydromorphone, into the illicit market is a concern, but it remains a minor part of overall opioid trafficking.
From a clinical perspective, Bach views safer supply as an additional tool in the treatment arsenal. While methadone and Suboxone are highly effective for many patients, safer supply can help those for whom these treatments are not suitable. Hydromorphone provides a predictable alternative to the unpredictable street drug supply, helping to stabilize patients and prevent overdoses. Bach stresses the importance of individualized treatment approaches, recognizing that different patients have different needs and goals.
Bach also addresses the terminology shift from "drug overdose" to "drug poisoning," reflecting the reality that many deaths are due to the unpredictable and contaminated drug supply rather than solely addiction. He emphasizes the need to combat stigma and ensure that individuals do not have to use drugs alone, as this increases the risk of fatal overdoses.
