Cited studies:
1. Bardwell G, Ivsins A, Mansoor M, Nolan S, Kerr T. Safer opioid supply via a biometric dispensing machine: a qualitative study of barriers, facilitators and associated outcomes. Can Med Assoc J. 2023;195(19):E668-E76.
2. Klimas J, Hamilton MA, Carney G, et al. Individualized prescribing portraits to reduce inappropriate initiation of opioid analgesics to opioid naïve patients in primary care: Protocol for a randomized controlled trial. Contemp Clin Trials. 2021:106462.
3. Santo T, Jr., Clark B, Hickman M, et al. Association of Opioid agonist treatment with all-cause mortality and specific causes of death among people with opioid dependence: A systematic review and meta-analysis. JAMA Psych. 2021;78(9):979-993.
4. BC Coroners Service. Unregulated Drug Deaths in B.C. (to May 31, 2023) Victoria, BC: Ministry of Public Safety & Solicitor General; 2023 [updated June 13; cited 2023 July 17]. Available from: https://www2.gov.bc.ca/gov/content/life-events/death
5. Narayan S, Brath H, Di Marco D, Maclure M, McCracken R, Klimas J. “I’m almost opioid-a-phobic”: family medicine residents’ perceptions of enhancing opioid analgesic and agonist treatment training in a Canadian setting. Educ Prim Care. 2023:1-7.
Many physician-focused interventions, including peer comparison letters, training, and academic detailing, have been studied to reduce opioid prescriptions in primary care.(2) These interventions were justified by older Canadian and US data that highlighted high rates of pharmaceutical opioid use, including non-medical use.(3) Yet, pharmaceutical opioids are no longer driving the current crisis.(4) This narrow focus on reducing opioid prescribing for chronic non-cancer pain may have inadvertently deterred physicians from prescribing opioid agonists, slow-release oral morphine, and hydromorphone for severe OUD.(5) Therefore, caution must be exercised when using feedback programs to reduce opioid prescribing by family physicians, as recent evidence and our own large randomized evaluation in BC suggest their limited effectiveness.(2)
Shifting Focus, Accelerating Innovative Vending Machines
While primary care providers play a vital role in managing OUD, we need to understand their optimal involvement in screening, treatment, and risk mitigation. Treatment of OUD and improving the purity of substances used by PWOUD are distinct issues that require separate attention. This is similar to the difference between screening and treatment of tobacco or alcohol use disorders and the regulation and policing of tobacco and alcohol. Primary care providers are well suited to do screening / treatment, but to expect these providers to also do the work of ensuring reliable access to tobacco or alcohol would be unreasonable.
The drug poisoning crisis demands urgent action and a shift in focus towards addressing the adulterants in drug supply rather than using limited resources to reduce opioid prescribing. By clarifying roles, identifying gaps, and expediting the implementation of evidence-based interventions, we can make meaningful progress in mitigating the crisis and protecting vulnerable individuals.