Hydromorphone dispensing across public health units in Ontario, Canada

Background
Given the heightened unpredictability and potency of the unregulated drug supply, prescribed Safer Opioid Supply (SOS) emerged as a harm reduction intervention aimed at mitigating overdose risk and related harms among those at high risk of overdose.

Objective
This study aimed to estimate the overall and SOS-related volumes and rates of oral hydromorphone dispensing among Public Health Units (PHUs) in Ontario.

Methods
We conducted a cross-sectional study to describe the use, volume, and rates of oral hydromorphone (immediate-release or controlled-release) dispensed across Ontario’s 34 PHUs from January to December 2023.

Results
Between January and December 2023, we observed considerable regional variability in the dispensing patterns of oral hydromorphone, both overall and in patterns of prescribing consistent with SOS. In 2023, 2,730 Ontarians received a prescription for immediate-release oral hydromorphone for SOS, constituting 0.64% of all people dispensed oral hydromorphone (N=424,633) across the province and found significant variation in the the rates of hydromorphone dispensed across PHUs.

Conclusion
Oral hydromorphone dispensing varied considerably by region, particularly for SOS dispensing, reflecting differences in opioid-related harms, access to SOS, and funding for SOS across PHUs. Our findings highlight the need for continued monitoring of SOS dispensing and demonstrate the importance of tailoring harm reduction strategies to meet regional needs and changing patterns of opioid tolerance.

Date Released: June 18, 2025