ArticleBMJ (Clinical research ed.)2024
Effect of Risk Mitigation Guidance opioid and stimulant dispensations on mortality and acute care visits during dual public health emergencies: retrospective cohort study.
Article in BMJ (Clinical research ed.), 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 56 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
56 citing papers in PubMed, 2 syntheses or guidelines pooled it, 84 citations in OpenAlex.
- Oxygen Saturation Thresholds for Opioid-induced Respiratory Depression: A Systematic Review.The western journal of emergency medicine · 2026Pooled it
- Safer opioid supply clients' values and preferences: a systematic review and thematic synthesis of qualitative research.BMJ mental health · 2025Pooled it
- Safer supply deprescribing during a toxic drug poisoning crisis in Vancouver, Canada.Drug and alcohol dependence · 2026Article
- "Anybody who Looks at This Program and Doesn't See the Positive Side from it Doesn't Fully Understand": Participant Perspectives on an Injectable Opioid Agonist Treatment Program in New Brunswick, Canada.Contemporary drug problems · 2026Article
- Prescribed pharmaceutical alternatives initiative coinciding with reductions in unregulated street opioid use among young people who use drugs: An interrupted time series analysis.Addiction (Abingdon, England) · 2026Article
- "Safer supply is the thing that changes everything": the role of prescribed safer supply in rebuilding trust following experiences of medical abandonment.BMC public health · 2026Article
- Participant perspectives on a safe supply program in Vancouver, Canada: impacts, satisfaction and improvement priorities.Harm reduction journal · 2026Article
- A continuum of disconnection: the impacts of safer supply program closures on continuity of care, transition, and total loss of service access.Harm reduction journal · 2026Article
- Safe Supply at Insite, North America's First Supervised Consumption Site: A Case Report of Reduced Harms From the Toxic Drug Supply in a Client Prescribed Powdered Fentanyl Alternative.Drug and alcohol review · 2026Article
- "With this you're not chained down to something": contrasting experiences of opioid agonist treatment and safer supply program participation among people receiving prescribed safer supply.Harm reduction journal · 2026Article
- How population-level drug supply data are integrated into health outcomes research: a scoping review.Epidemiologic reviews · 2026Article
- Unintentional benzodiazepine use and frequency of drug checking service utilization: a cross-sectional study.Harm reduction journal · 2026Article
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- Substances and substance combinations among accidental substance-related acute toxicity deaths (AATDs) in Canada from 2016 to 2017.BMC public health · 2025Article
- A sea of need: provider accounts of strategies used to manage admission demands to safer opioid supply programs in Ontario.Harm reduction journal · 2025Article
- Public support of and attitudes toward decriminalization of possession of illegal drugs among the general population in British Columbia.Substance abuse treatment, prevention, and policy · 2025Article
- A qualitative study exploring motives for the transition from injecting to smoking drugs in Vancouver, British Columbia.The International journal on drug policy · 2025Article
- Drug decriminalization: a co-designed study outlining the implications for providers of youth services.Harm reduction journal · 2025Article
Corrections and comments
- Commented on by
- Erratum issued
Authors and funding
12 authors at 4 institutions in 1 country.
Funding
Abstract
objectiveTo determine the effect of opioid and stimulant Risk Mitigation Guidance (RMG) dispensations on mortality and acute care visits during the dual public health emergencies of overdose and covid-19.
designPopulation based retrospective cohort study.
settingBritish Columbia, Canada.
participants5882 people with opioid or stimulant use disorder who received RMG prescriptions for opioids (n=5356) and/or stimulants (n=1061) (535 received both) from 27 March 2020 to 31 August 2021.
main outcome measuresAll cause and overdose specific mortality and acute care visits in the week after RMG opioid or stimulant dispensation. RMG recipients were matched 1:1 with controls through use of high dimensional propensity score matching. Marginal structural models, executed on weekly time steps, were used to measure the effect of dispensations on outcomes.
resultsRMG opioid dispensations of one day or more were associated with reduced all cause mortality (adjusted hazard ratio 0.39, 95% confidence interval 0.25 to 0.60) and overdose related mortality (0.45, 0.27 to 0.75) in the subsequent week. Dispensations of RMG stimulants (≥1 days) were not significantly associated with reduced all cause mortality (adjusted hazard ratio 0.50, 0.20 to 1.23) or overdose related mortality (0.53, 0.18 to 1.56). The protective effect of RMG opioid dispensations increased with the number of days the medications were dispensed in a given week. People who received four or more days of RMG opioid dispensations had reduced all cause mortality (adjusted hazard ratio 0.09, 0.04 to 0.21) and overdose related mortality (0.11, 0.04 to 0.32) compared with the control group. Opioid RMG dispensations did not significantly modify the odds of all cause or overdose related acute care visits. Dispensations of RMG stimulants were associated with a significant decrease in the odds of acute care visits for any cause but did not affect the odds of overdose related acute care visits.
conclusionsRMG opioid dispensations were associated with reduced overdose related and all cause mortality among a sample of people with opioid use disorder. Pharmaceutical alternatives to the illegal drug supply are promising interventions to reduce mortality in people with opioid use disorder.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.