A new Canadian study has found that two different treatment programs—methadone and safer opioid supply (SOS)—can both significantly reduce overdoses, hospital visits, and health care costs for people struggling with opioid addiction.
The research, done by ICES and Unity Health Toronto, was published in The Lancet Public Health and is one of the first to directly compare these two approaches at the population level.
The safer opioid supply (SOS) program gives people pharmaceutical-grade opioids, such as hydromorphone, as a safer alternative to street drugs.
Street drugs are often very strong, unpredictable, and sometimes contaminated, which makes them especially dangerous and leads to a high risk of overdose.
Methadone, on the other hand, is a long-standing treatment that helps reduce cravings and withdrawal symptoms by acting on the same parts of the brain as opioids without producing a “high.”
The study looked at people in Ontario who started either SOS or methadone treatment between 2016 and 2021, with follow-up data collected until the end of 2022. In total, researchers identified 991 people who started SOS and over 26,000 who started methadone treatment.
Interestingly, people entering the SOS program were generally in worse health than those starting methadone. Many had already experienced serious health problems, including HIV, hepatitis C, and previous overdoses. This shows that the SOS program may be reaching people who are in more urgent need of help.
To make a fair comparison, the researchers matched 856 people in the SOS program with 856 people in the methadone group who had similar health backgrounds, ages, and who lived in similar communities.
After one year, both groups showed major improvements. There were fewer overdoses, fewer emergency room visits, fewer hospital stays, fewer new infections, and lower overall healthcare costs. Deaths from opioids or any cause were also rare in both groups.
While methadone users had slightly fewer overdoses and hospital admissions than SOS users at first glance, they were also more likely to stop treatment early. Once researchers accounted for this high dropout rate, most of the differences between the two groups disappeared. The only consistent benefit that methadone kept was a slightly lower rate of toxic side effects.
The key message from the study is that both treatment options work well, but they are not the same. According to lead researcher Dr. Tara Gomes, some people benefit from methadone, while others may not respond well to it or may not stay in treatment. For those people, SOS programs can be a vital alternative that keeps them engaged and reduces their risk of harm.
The researchers suggest that the slightly better results seen with methadone may be due to the fact that people starting methadone were less medically complex and had milder forms of opioid use disorder compared to those in the SOS program. In other words, SOS is helping people who are more at risk and harder to reach with traditional treatments.
This study supports the idea that SOS and methadone shouldn’t be seen as competing methods, but rather as two important tools that work best when offered together. By having more options, doctors and support programs can better help people based on their unique needs.
For many individuals who have not succeeded with standard treatments like methadone, SOS programs may provide a lifeline and reduce harm in communities hit hardest by the opioid crisis.
In conclusion, this study shows that both safer opioid supply and methadone are effective in lowering overdoses, improving health, and reducing the burden on the healthcare system. Methadone may offer a slight edge in some areas, but SOS programs are reaching people with more severe health issues who might otherwise be left behind.
Together, these treatment programs offer hope and practical solutions for one of today’s most urgent public health problems.
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The research findings can be found in The Lancet Public Health.
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