The COVID-19 pandemic was preceded by an ongoing overdose crisis and linked to escalating drug overdose deaths in British Columbia (BC). At the outset of these dual public health emergencies, the BC government announced interim Risk Mitigation Guidance (RMG) that permitted prescribing medication alternatives to substances, including opioids, alcohol, stimulants, and benzodiazepines, an intervention sometimes referred to as ‘Safe Supply’. This protocol outlines the approach for a study of the implementation of RMG and its impacts on COVID-19 infection, drug-related and systemic harms, continuity of care for people with substance use disorder, as well as their behavioural, psychosocial, and well-being outcomes.
We conduct a parallel mixed-method study that involves both analysis of population-level administrative health data and primary data collection, including a 10-week longitudinal observational study (target n=200), a cross-sectional survey (target n=200), and qualitative interviews (target n=60). We have implemented a participatory approach to this evaluation, partnering with people with lived or living experience of substance use, as well as researchers and public health decision-makers across the province. Linked population-level administrative databases will analyze data from a cohort of BC residents with an indication of substance use disorder between 1996 and 2000. We will conduct a high-dimensional propensity score matching and marginal structural modeling to construct a control group and assess the impact of RMG dispensation receipt on a collaboratively-determined set of primary and secondary outcomes.
This study constitutes the first formal evaluation of a province-wide program providing regulated pharmaceutical alternatives to the toxic drug supply. The study features an integrated knowledge translation approach, including communications with people with lived/living experience of substance use and consortium meetings with various stakeholders. Supported by the unique research context in BC, our selected mixed method study design will provide an exceptionally strong evidence base to judge not only the impact of the initial implementation of RMG, but also critical evidence on the implementation of the program, which can be used to adapt its future iterations if deemed successful.