Virtual clinics now prescribe safer-supply drugs as opioid crisis escalates

May 14, 2024

Three virtual healthcare clinics based in London, Hamilton, and Toronto now prescribe safer-supply opioid medication to patients with opioid use disorder. The medication, hydromorphone, available under the brand name Dilaudid, is used as a safer alternative to opioids sold as part of illicit supply, which often contain dangerous adulterants such as benzodiazepines and fentanyl.

The healthcare clinics provide several pharmacies with urine sample testing kits to test for the presence of prescribed medication, as well as illicit drugs. The purpose of the testing procedure is to ensure the patient takes their prescription to prevent diversion, and does not sell it for street drugs, an act also referred to as diversion. 

“We are the first line of contact for patients who have been using the contaminated street supply and we have seen the difference in them when they are prescribed safer supply,” said Nasir Ladak, pharmacist and manager of Chapman’s Pharmacy in London, in his interview with CBC News.

“The urine test can detect morphine or fentanyl so we know if patients might be using from the street supply,” Ladak added. “The prescriber can see it at their end and they discuss their findings with the patients.” The pharmacist also added that he has witnessed the use of safer supply leading to improved patient outcomes. “Their secondary conditions, their overall health, their mental-health issues — we definitely see positive health outcomes,” Ladak said. “A person completely out on the street has so many health issues and when they start using the safer supply, the prescribers can target the secondary issues.”

Dr. Andrea Sereda’s clinic at the London Intercommunity Health Centre has received funding from Health Canada to provide comprehensive care for addiction use disorder including case managers, nurses and social workers. “We prescribe [safer supply] to patients who are very high risk. We can only see about 300 people for our intensive safer-supply program, but we know there are at least 6,000 people in London who use fentanyl,” Dr. Sereda said. “We know that 80 per cent of people who die of fentanyl overdoses are housed members of the community who have jobs they go to every day, people you might see at the bank or the grocery store. Virtual health care models could be quite appropriate for them.”

However, some health experts have also voiced concerns over the use of dilaudid to treat opioid use disorder. Dr. Martyn Judson, who prescribes methadone and suboxone as part of addiction treatment in London, told CBC News he does not support the safer supply clinics. “Suboxone and methadone stop patients from feeling euphoric and prevents people from getting high from using other opioids,” he said. This supposed safer supply, Dilaudid, is short-acting, rapidly absorbed, causes euphoria and a patient goes into withdrawal five or six hours after taking the drug.” 

According to data released by the Ontario Drug Policy Research Network and Public Health Ontario (ODPRN), there’s been a 31% increase in opioid-related deaths in Ontario from January 2020 to September 2022.