A population-based cross-sectional study

Background
Safer opioid supply involves prescribed pharmaceutical opioids as alternatives to unregulated drug supply for people at high-risk of opioid toxicity. In Canada, this is primarily achieved through prescribing immediate-release hydromorphone, often combined with methadone.

Objective
This study examined the trends and patterns in the dispensing of immediate-release hydromorphone for SOS in Ontario, Canada.

Methods
We conducted a population-based repeated cross-sectional study to analyze monthly trends in immediate-release hydromorphone prescribing for safer opioid supply, dosing patterns, and proportion of oral hydromorphone dispensed for safer opioid supply in Ontario from 2016 to 2023.

Results
Monthly safer opioid supply participation was low before January 2019 (range 0.18 -0.47 per 100,000), before slowly rising (+0.09 per 100,000 monthly), until June 2020 when it rapidly increased (+0.54 per 100,000, monthly). In 2023, among 2,730 safer opioid supply recipients, 62.3 % were male (mean age, 42 years). During the study period, mean immediate-release hydromorphone doses for safer opioid supply also rose, with notable accelerations occurring between October 2018 and December 2019, and again between April 2020 and January 2021. By December 2023, mean daily immediate-release hydromorphone doses reached 172 mg, and safer opioid supply programs accounted for 22.5 % of all oral hydromorphone dispensed in Ontario.

Conclusion
An accelerating number of safer opioid supply recipients over time, coupled with rising immediate-release hydromorphone doses likely reflects efforts to meet the needs of people who use drugs in the context of an increasingly potent unregulated opioid supply, particularly as this supply changed throughout the COVID-19 pandemic.

Date Released: June 28, 2025