Grant: Project Grant

The Canadian opioid toxicity epidemic has claimed over 32,000 lives since 2016. It is estimated that two-thirds of opioid-related deaths occur among people with opioid use disorder. While first-line treatments are generally safe and effective, the emergence of fentanyl in the unregulated drug supply has led to increased opioid tolerance among people with opioid use disorder. Specifically, those who use fentanyl are often unsatisfied with traditional treatment approaches, placing them at increased risk of stopping treatment and subsequent opioid-related harm. To improve continuity of care, prescribing guidance for opioid agonist treatments have changed rapidly over the past two years, with recommendations for starting treatment with slow-release oral morphine and methadone combined, higher methadone dosing, and providing flexible methadone take-home doses. However, due to the urgent need for new treatment options, these recommendations were largely made in the absence of clinical evidence surrounding their safety and effectiveness. Therefore, we propose a body of work that will use linked healthcare data in Ontario, Canada to describe changing methadone and slow-release oral morphine prescribing patterns and evaluate the safety and effectiveness of new treatment approaches. The proposed research questions were guided by a diverse group of patients, researchers, and clinicians, who will continue to oversee this work to ensure its relevance. As people with opioid use disorder often experience challenges maintaining engagement with treatment, expansion of treatment options is an urgent priority. Through generation of real-world evidence on the safety and effectiveness of evolving opioid agonist treatment approaches, our work will inform refinement of opioid use disorder guidelines, improve patient adherence to treatment and help decrease lives lost to Canada's toxic unregulated drug supply.