The Effect of Harm Reduction Policies on Overdoses: Evidence from Canada

• In Event: Policies related to Opioid Use and Health Outcomes

Abstract

Canada has been facing an opioid epidemic since 1999, and annual opioid overdoses now exceed 7,000 (Government of Canada 2024). Canada is at the forefront of harm reduction, an alternative to criminalization of substance use, to address the epidemic. In this paper, I focus on the effect of two specific harm reduction policies: safer opioid supply (SOS) and supervised consumption sites (SCS). SOS provides pharmaceutical-grade opioids to people who use drugs that are typically only obtainable on the unregulated market, and SCS are meant for the use of pre-obtained drugs in a safe environment under medical supervision. These programs aim to prevent overdoses by providing medical intervention when signs of overdose appear or limiting exposure to opioids contaminated with illicit fentanyl.

How such programs may affect opioid-related health outcomes is theoretically ambiguous. Supervised consumption sites are meant to prevent overdose by providing safe places to consume and monitoring for signs of overdose. It is possible that, due to this lowered risk of fatal overdose, the expansion of these facilities could cause a reduction in opioid overdoses in their localities. Alternatively, opening supervised consumption sites might draw people who use drugs to the area, plausibly increasing public disorder and crime, and ultimately lead to more illicit drug use. Similar arguments can be made for safe supply programs. On one hand, safe supply reduces the likelihood that people who use drugs, both those enrolled in safe supply programs and those who may use diverted opioids supplied by those programs, will be exposed to a harmful contaminant. On the other hand, access to a safer supply of opioids may reduce the perceived risk of opioid overdose, creating a potential moral hazard effect that leads to increased risk of opioid use and overdose even in the absence of fentanyl.

Small scale studies in the medical and public health literatures generally find improvements in opioid overdoses and infectious complications for the people that use these programs. The size and nature of existing studies prevent them from providing credible causal estimates of their effects. The health economics literature finds that harm reduction policies may have unintended negative consequences (Doleac and Mukherjee 2022; Packham 2022).  

To estimate the net effect of these programs on opioid-related outcomes, I exploit variation in their openings across Canada’s geography and over time. Since 2020, over 50 programs have opened, mostly in major metropolitan areas (Health Canada 2023). In this study, I use quasi-experimental approaches to estimate the causal effect of the implementation of these programs on overdose mortality and overdose-related emergency department visits.

The empirical results will provide important information about innovative recent policies to address the opioid epidemic, which is one of the greatest public health challenges facing North America. More generally, it contributes to the literature on consumer responsiveness to health information.

Author

• Chloe Smith, Cornell University
  Presenting Author