Okay. Are we ready?
Good morning. Thank you for the invitation to attend this meeting.
This study was conducted at a true provincial scale using B.C.'s linked health administrative datasets. My research team has specialized in the use of these data over the past 17 years and has been supporting the province's response to the overdose crisis since its declaration.
In its first 18 months, just under 6,000 of the estimated 250,000 opioid and psychostimulant users in British Columbia accessed the program. These 6,000 included just over 5,000 people with an opioid use disorder, of whom we estimate there are over 100,000 in British Columbia.
Those accessing the program tended to have long histories of substance use disorders, were socially marginalized and were at high risk of overdose death. As the program was designed to reduce the risk of overdose and death among recipients, we focused on these outcomes to determine whether the initiative had its desired effect. We otherwise focused on the immediate effects of RMG dispensations given the fact that—like birth control pills or insulin for diabetes or even opioid agonist treatment—their effects should only be expected to persist while in use.
As the guidance was issued provincially and on an emergency basis at the onset of the COVID-19 pandemic, a randomized control trial was not possible. As such, a population-based study using extensive linked health administrative data represents a best possible study design. Moreover, we executed the study at the highest possible methodological standard. As noted, it was recently published in one of the highest-impact medical journals.
The intended mechanism of the RMG program was to separate individuals from the toxic illicit drug supply. Our findings suggest this mechanism was realized. People had lower risk of death while they were receiving RMG dispensations, and more frequent receipt was associated with a stronger protective effect. That's a crucial piece of evidence. It's what we call a “dose response” effect, and it's one of the key conditions that we look for in a causal effect in epidemiology.
These effects were independent of any concurrent opioid agonist treatment prescription or other potential confounding factors that were apparent at baseline or which may have changed over the course of time after individuals initiated RMG. These effects otherwise held true, whether we considered drug-related or all-cause mortality, and we found comparable effects for stimulant RMG dispensations, though far fewer people received them and so there was a greater degree of uncertainty in these findings.
The risk mitigation guidance has been a controversial program, drawing criticism within B.C. and across Canada since its implementation long before our study's publication. Scholarly debate—that is, debate based not on ideology or anecdote but on scientific evidence—is a useful and constructive part of the decision-making process. In that spirit, our team systematically and with additional analysis and evidence addressed each of the critiques we received after our study was released via public presentation delivered on February 7, which has been posted online.
I've made this presentation and all other peer-reviewed articles and reports that I'll be referring to available to the committee; I think we need some time for the French translation to come through.
To summarize, our study demonstrated that for the relatively few people who were able to access it, the RMG program or prescribed safer supply saved lives.
Moving forward, we hope these facts and the lives of some of the most vulnerable Canadians are sufficiently considered and will inform debate and decisions about this intervention, one of a continuum of different services that we require to address the opioid crisis.
Thank you.