Machine-Based Opioid Dispensing Reduced Drug-Related Harms

A British Columbia program that uses biometric dispensing machines to supply pharmaceutical-grade opioids to patients with opioid use disorder reduced drug-related harms and could potentially overcome barriers that hamper other safer supply strategies, an analysis has found.

Characteristics that encouraged use of the biometric supply platform included accessibility and participant choice, a lack of consequences for missing doses, witness-free dosing, lack of judgment, and an ability to accumulate doses. Barriers included technical issues with the dispensing machine, dosing challenges, and prescriptions being tied to individual machines.

Geoff Bardwell, PhD

“What’s at stake here is providing greater autonomy, accessibility, and really just the flexibility with medication dosing and how medication is dispensed, compared to other programs — not just other safer opioid supply programs in Canada, but also thinking about treatments such as methadone or buprenorphine,” lead researcher Geoff Bardwell, PhD, a research scientist with the British Columbia Centre on Substance Use (BCCSU) and an assistant professor at the School of Public Health Sciences at the University of Waterloo, Waterloo, Ontario, Canada, told Medscape Medical News.

The study was published May 15 in the Canadian Medical Association Journal.

Opioid Deaths Spiked

As they have in the United States, opioid-related deaths in Canada have spiked in recent years. According to Public Health Agency of Canada data, annual opioid toxicity deaths have doubled since 2019. While the number of deaths in the first 9 months of 2022 (the last period for which the agency has data) is about 8% lower than during the same period in 2021, it is still double the prepandemic rate.

In response, the Canadian federal government has provided funding for safer supply pilot programs. A study last year in the International Journal of Drug Policy reported that the number of safer supply sites in Canada increased by 285% between March and May 2020 in response to the COVID-19 pandemic.

Typically, safer supply programs require participants to be at a certain place, such as a clinic or treatment center, at a specific time to get their doses and meet with staff. “That process can be really shameful and stigmatizing and lacks privacy,” said Bardwell.

The MySafe program placed biometric machines in two supportive housing settings in Vancouver and one in Victoria that enabled participants to access doses at their convenience without any staff interaction. Another machine was placed in an overdose prevention site in Vancouver.

A local pharmacy dispenses the medications, and MySafe staff manually loads the prescribed doses, in the form of packaged, daily doses of tablets, into the machines. A participant accesses a dose by scanning his or her handprint, and the machine dispenses it. Participants are expected to take their medications daily. They have medical evaluations at enrollment and at 1, 6, and 12 months.

“If you think you have to go somewhere every single day to get your medications, maybe that’s something you can do, but on top of that, add in these real-world consequences as being identified as someone on a particular medication,” said Bardwell. “When we think about the MySafe program, yes, there’s a finding related to access to this particular medication, but I think it has merit in terms of how we might think about delivery of other medications.”

Decreased Overdose Risk

The qualitive study used a questionnaire that the researchers developed with input from a community advisory board consisting of clinical staff and people with a history of drug use. Researchers conducted one-to-one interviews with 46 participants in the MySafe program from November 2021 to April 2022.

MySafe participants reported that they used fewer illicit drugs, felt that they had a lower overdose risk, and an improved sense of health and well-being since they enrolled in the program. They also reported a positive financial impact.

The study also found barriers to accessing the program. Almost every participant had technical problems with the machines, at times leading them to go into withdrawal or buy drugs illegally. Sometimes their medications didn’t match the current strength of illicit opioids. About a third of participants had concerns about their prescriptions being tied to a specific machine. If they were registered to a machine in their supportive housing building, they couldn’t be registered to the machine at the overdose treatment site, and vice versa.

The qualitative design is a strength of the study, said Bardwell. “Because it’s a qualitative study, we were able to do a deep dive on particular experiences, which are obvious limitations to quantitative studies,” he said. Another strength was “working with a community advisory board to be sure we’re asking the right questions.”

The study is part of a larger, mixed-methods, longitudinal evaluation of the MySafe program, said Bardwell.

Qualitative Studies ‘Required’

Commenting on the study for Medscape, Rebecca Saah, PhD, an associate professor at the Cumming School of Medicine at the University of Calgary, Calgary, Alberta, Canada, said that the expansion of safer supply programs has been “particularly contentious and weaponized by various federal and local politicians.” Saah did not participate in the research.

“This study is really needed,” said Saah. “This type of research that engages very painstakingly and meaningfully with a very hard-to-reach, marginalized population takes a tremendous amount of effort to do well. They really engaged in depth with the population and got a high degree of diverse and honest responses.”

Saah rebutted criticism of the study’s qualitative methodology. “I’m a qualitative methodologist, I teach qualitative methodology to physicians and surgeons in our medical school here, and I think that qualitative research is absolutely required when you’re evaluating a novel intervention for a specific population, especially a marginalized population.”

The study was funded by Health Canada’s Substance Use and Addictions Program. Bardwell and Saah report no relevant financial relationships.

CMAJ. Published May 15, 2023. Full text.

Richard Mark Kirkner is a medical journalist based in the Philadelphia area.

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