Safer supply deprescribing during a toxic drug poisoning crisis in Vancouver, Canada.

Abstract

Since 2016, more than 53,000 Canadians have died from exposure to the toxic unregulated drug supply. In 2020, the British Columbia government implemented a program in which pharmaceutical alternatives to toxic unregulated drugs can be prescribed, known as "prescribed safer supply." Since 2023, the number of prescriptions and prescribers has declined, and people who use drugs (PWUD) in Vancouver have reported community-wide deprescription. We sought to examine the prevalence and predictors of deprescribing in Vancouver, BC. Using data from two Vancouver-based prospective cohorts of PWUD, we included participants who self-reported accessing prescribed safer supply. Generalized estimating equations were used to identify factors associated with deprescribing. Between December 2023 and November 2024, 353 eligible participants were included; 62 (17.6%) were deprescribed. In multivariable analyses, gender self-identification as a woman (adjusted odds ratio [AOR] = 1.92; 95% confidence interval [CI]: [1.06, 3.49]), nonfatal overdose (AOR = 3.35; 95% CI: [1.81, 6.17]), and challenges accessing addiction treatment (AOR = 4.51; 95% CI: [2.48, 8.21]) were positively associated with increased odds of deprescription. Among those deprescribed, 88.7% were deprescribed from tablet hydromorphone. Deprescribed participants reported increased use of unregulated drugs and negative health and social impacts. Negative urine drug screen results (38.7%), missed medication pickup or delivery (24.2%), and diversion (22.6%) were reported as reasons for deprescription. It remains unclear whether deprescribed patients are transitioned to other safer supply medications or drug treatments. More work is needed to assess the scope of safer supply deprescribing and illuminate its social-structural drivers.