Safer opioid supply improves health outcomes among people at high risk of overdose

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.” 

FOR FURTHER INFORMATION PLEASE CONTACT: 

Misty Pratt 
Senior Communications Associate, ICES 
Media@ices.on.ca  
343-961-6982 

About ICES  

ICES is an independent, not-for-profit research and analytics institute that uses population-based health information to produce knowledge on a broad range of healthcare issues. ICES leads cutting-edge studies and analyses evaluating healthcare policy, delivery, and population outcomes. Our knowledge is highly regarded in Canada and abroad and is widely used by government, hospitals, planners, and practitioners to make decisions about healthcare delivery and to develop policy. For the latest ICES news, follow us on BlueSky and LinkedIn: @ICESOntario  

About Unity Health Toronto 

Unity Health Toronto is one of the largest academic health sciences networks in Ontario with a wingspan across Toronto’s core. The breadth of services we provide, strengthened by community partnerships and our global profile in health research, education and innovation, positions us as a model for collaborative, integrated, high quality care as we work to build a stronger, resilient and equitable health system for all. 

Our mission and values, instilled over 130 years ago by the Sisters of St. Joseph of Toronto, drive our commitment to equity and social justice, as we seek to understand the challenges of disadvantaged populations and find new ways to eliminate the barriers they face. This mission is part of our legacy and ingrained in our culture. We know if we can get it right for those who need our help the most, we can have life changing impacts for all in society. 

Our motto – Caring hearts. Leading minds – captures our dual commitment to compassionate patient care and excellence in teaching, research and innovation. As a leading Canadian health research institution and learning destination of choice for top health professionals, we are advancing healthcare for all united by one vision: The best care experiences, created together.  

About St. Michael’s Hospital 

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in more than 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto. 

About the Ontario Drug Policy Research Network 

Established in 2008, the Ontario Drug Policy Research Network (ODPRN) is a research program based out of St. Michael’s Hospital that brings together researchers, people with lived experience, clinicians, and policy-makers to generate evidence to inform effective drug policy development in Ontario.