Toronto, ON, April 22, 2025 – Research from ICES and Unity Health Toronto shows that safer opioid supply programs and methadone both reduce opioid overdoses, healthcare utilization, and costs.
Safer opioid supply (SOS) programs provide pharmaceutical-grade opioids such as hydromorphone to people struggling with opioid use disorder. Prescribed opioid medications are a safer alternative to drugs found in the unregulated drug supply due to the potency and unpredictability of that supply.
"This is the first population-based study to compare SOS programs with opioid agonist treatment, and to explore how people's outcomes change in the year after initiation," says Dr. Tara Gomes, a scientist at the Li Ka Shing Knowledge Institute of St. Michael's Hospital and ICES, and a principal investigator of the Ontario Drug Policy Research Network (ODPRN.)
The researchers compared health outcomes among people newly prescribed SOS and those newly starting methadone as opioid agonist treatment (OAT) between 2016 and 2021, in Ontario, Canada, with follow-up extending to the end of 2022.
The study identified 991 people newly prescribed SOS and 26,116 new OAT (methadone) users. Patients prescribed SOS faced more medical issues, including higher rates of HIV, hepatitis C, previous opioid overdoses, and infections, suggesting that people prescribed safer supply were generally more medically complex than people prescribed methadone when starting treatment.
The researchers matched 856 new SOS patients to an equal number of methadone recipients who had similar health conditions, demographics, and lived in similar parts of the province. The report found that people in both the SOS and methadone groups had significant declines in opioid overdoses, emergency department (ED) visits, hospitalizations, new infections, and healthcare costs in the subsequent year.
In both groups, deaths related to opioids or any other cause were uncommon.
SOS and methadone treatments complementary
While both SOS and methadone recipients had an overall lower risk of overdose and poor health outcomes while on treatment, in a comparative analysis, individuals starting methadone had a slightly lower risk of experiencing an opioid overdose and being admitted to hospital compared to people starting safer supply. However, people starting methadone were more likely to discontinue treatment. After accounting for the higher rate of treatment drop-out in the methadone group, most of the benefits of methadone over SOS disappeared, with the exception of toxicities which remained slightly lower among those receiving methadone.
"Neither methadone nor safer supply programs are a one-size-fits-all solution, but our findings show that both are effective at reducing overdose and improving health outcomes," adds Gomes. "They are complementary to each other, and for many people who haven't found success with traditional treatments like methadone, safer supply programs offer a lifeline. Our findings show that when safer supply programs are implemented, we see fewer hospital visits, fewer infections, and fewer overdoses."
The authors speculate that the different patterns of unregulated drug use between the two groups and the higher severity of opioid use disorder among SOS recipients may partly account for why the risk of opioid overdose was lower among methadone recipients compared to people receiving safer supply.
"These findings highlight the value of including safer supply alongside OAT in our toolbox of programs and services designed to support people at risk of overdose in Ontario," says Gomes. "Safer opioid supply programs are reaching those with high medical complexity and a history of serious harms from drug use – those in our community who need support the most."
