Mohammad Karamouzian is an Assistant Professor at the University of Toronto's School of Public Health and a Research Scientist at the Centre on Drug Policy Evaluation (CDPE). Mohammad’s research focuses on addressing health inequities faced by marginalized populations (e.g., female sex workers, people who inject drugs, people who are incarcerated).

Introduction: The MySafe program in Vancouver, Canada is a novel safer supply (i.e., non-witnessed prescribed opioid medication) intervention involving the provision of hydromorphone tablets through a secure-access dispensing machine. This service was developed to offset the need for daily pharmacy pickup, which some individuals find to be restrictive and stigmatizing. In this study, we aimed to quantitatively characterize program participants and machine usage patterns to inform efforts to optimize the implementation of MySafe and other safer supply programs in Canada.

Methods: Using administrative data from the dispensing machines and surveys with participants, we characterized program participants, their satisfaction with the MySafe program, and machine dispensing patterns from January 2020 to September 2022. Baseline and follow-up surveys queried socio-demographics and substance use patterns post-enrollment. Eligibility criteria included self-reporting daily fentanyl use, expressing an interest in being prescribed hydromorphone pills, and being at a high risk of opioid overdose.

Results: Overall, 96 participants (median age = 40) were recruited of which 66 (69%) completed a follow-up survey (median: 7.8 months after baseline). In total, 13,323 total visits were recorded. The majority of visits (76%; n=10,126) occurred between 5 p.m. and 11 p.m., which is a time period outside of typical pharmacy operating hours. All 66 participants reported satisfaction with the MySafe program, reduced use of unregulated opioids and other drugs, and decreased engagement with the street economy. Qualitative urinalysis via urine drug screening revealed continued use of fentanyl and methamphetamine, which aligns with participants reporting reduced illicit drug use but not full cessation. Other findings include a sharp decrease in cocaine, and an increase in benzodiazepine, which may reflect drug market changes.

Conclusions: Some areas of improvement include adjusting medication dosages and addressing occasional automated dispensation challenges. These findings can inform policy decisions concerning the optimization of models of prescribed opioid medications.