Background: In the context of the COVID pandemic and drug poisoning deaths, prescribed “safer supply” (PSS) of pharmaceutical medications was introduced in 2020 in BC as alternatives to toxic street drugs. The most prescribed opioid was hydromorphone. This study examined trends in non-prescribed hydromorphone availability, price, and initiation.
Methods: Between 2015 and 2022, data was collected from a cohort of street-involved young people in Vancouver. Extended Cox proportional hazards models were used to assess if COVID and the introduction of PSS were associated with non-prescribed hydromorphone initiation among participants age <30 years.
Results: During the study period, the street price of hydromorphone dropped from $10 to $1 per 8mg pill. The proportion of participants who reported being able to obtain non-prescribed hydromorphone within 90 minutes increased from 15% in December 2018 to 55% in 2021. Of the 293 participants included in the Cox analyses (who had no history of hydromorphone use at baseline), the mean baseline age was 23.3 and 29 (9.9%) participants initiated non-prescribed hydromorphone use. In the multivariable extended Cox model, the COVID/PSS era was not associated with initiation.
Discussion: The reduction in non-prescribed hydromorphone price and increased availability suggests a surge in supply. However, among this study sample, no significant increase in the rate of initiation was observed. Despite increased availability and low price, street-involved young people who use drugs were not more likely to start using non-prescribed hydromorphone after the pandemic and introduction of PSS.