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ROCHESTER — Sometimes the greater good is the greater good — even if that means supplying addictive substances to persons with chemical dependency in exchange for compliance during a pandemic.
That was the thinking behind a May 2021 so-called "safe supply" project serving occupants of isolation shelters in Halifax, Nova Scotia. The work is known as “risk mitigation,” or “pandemic prescribing,” and was recently reported in the preprint journal medrxiv.org .
That paper reported how health care workers responded following a COVID-19 outbreak in the Halifax congregate shelter system last spring. A multidisciplinary team was dispatched to provide prescription medications and alcoholic beverages to occupants in need while secluded under health orders in COVID-19 hotel shelters.
The resulting retrospective review paper, by researchers from Dalhousie University and University College London, examined the safety and effectiveness of this initiative, which provided beer, wine, liquor, opioids, stimulants and benzodiazepines as needed, in exchange for isolation adherence among persons experiencing homelessness.
The 25-day project admitted 77 residents to a staffed floor of hotel rooms turned into isolation shelters. Addiction medicine specialists assessed residents upon arrival about their concerns regarding the potential for experiencing withdrawal from alcohol, medication or cigarettes. Just 15, or 19%, responded that they had no such concerns.
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Of the rest:
- 17 received opioid replacement medications
- 27 received the opioid Dilaudid
- 31 received Ritalin or another stimulant
- 6 received benzodiazepines
- 42 received alcohol, primarily in the form of beer
Some participants may have received more than one substance over the course of the study.
Over 14 days, just six residents left prematurely, and four of those later returned.
No residents experienced overdoses, with workers reporting intoxication on six occasions and diversion on three occasions, according to the paper.
"We found that an emergency, provisional safe supply program providing pharmaceutical-grade medications and beverage-grade alcohol in COVID-19 isolation hotel shelters was associated with low rates of adverse events and of high rates of successful completion of the mandatory 14-day isolation stay," the authors reported. "This suggests this approach is safe and effective in this setting."
The effort also tracked the degree to which the residents increased their intake over time. "Over 14 days in isolation," the authors reported, "mean daily dosages increased" for both opioids and alcohol, the latter from 12 to 13 drinks.
The initiative stems from an ongoing call to rethink of drug and alcohol policy in such a way to reduce worsening effects of the criminal justice system, poor health, drug adulteration and poverty, an approach known as "harm reduction."
Because the findings were published on the pre-publication health sciences server medrxiv, it is research that has not yet been peer reviewed, and therefore should be read with caution.
