Background: British Columbia, Canada introduced the Risk Mitigation Guidance to support the prescription of pharmaceutical alternatives to the toxic unregulated drug supply in 2020. This provincial prospective cohort study evaluates the impact of prescriptions on self-reported psychosocial outcomes, including health-related quality of life, depression, anxiety, frequency of unregulated substance use, COVID-19 protective behaviours, and reliance on criminalized income sources.
Methods: Data were collected using a longitudinal survey of people who had received a prescription or were seeking one out (n=161), with up to 5 time points per participant over 3 months. Generalised estimating equations (GEE) were used to assess the effects of time-varying prescription exposure on outcomes over follow-up period, controlling for encounters with police and bylaw officers, service use, social support, and sociodemographic characteristics.
Results: There was no evidence of an effect of prescription receipt on the change in any outcome over time. There was also no evidence of change in outcomes over the 12-week follow-up period independent of prescription status. The one exception was for COVID-19 protective behaviours, which showed a very small increase over time (adj. β = 0.0044, 95% CI = 0.001, 0.008). Point estimates suggested small overall protective effects of prescription status on depression (adj. β=-0.34, 95% CI=-0.82-0.14) and frequency of unregulated substance use (adj. β = -0.21, 95% CI = -0.48-0.061) over the follow-up period, although confidence intervals included the null value.
Discussion: Findings signal the potential promise of prescribed safer supply, along with the need for improvement. Further work is needed to inform the development of service models that combine prescriptions with comprehensive services and supports to maximize positive outcomes.