Grant: CIHR Fellowship

Canada is facing a deadly overdose epidemic. As synthetic opioids fuel a rise in opioid-related deaths, overdose deaths involving stimulants are skyrocketing. British Columbia (BC) published clinical guidelines for managing opioid use disorder in 2017. The guidelines recommend care providers should prescribe suitable opioid agonist medications based on each person's specific needs. Available opioid agonist medications include buprenorphine/naloxone, methadone, and slow-release oral morphine. Yet, compared to patients with opioid use disorder alone, these medications may result in different treatment outcomes among patients with both opioid and stimulant use disorders. The current guidelines for managing opioid use disorder do not cover common situations where people use both opioids and stimulants. Effective medication for stimulant use disorder is also not available. Therefore, my proposed research aims to find the best opioid agonist medication for individuals with both opioid and stimulant use disorder. This study will analyze the medical histories of patients registered with the provincial health insurance client roster in BC. Data will include an estimate of over 80,000 patients diagnosed with opioid use disorder. This research will (1) describe the trends in prescribing types of opioid agonist medications and treatment dropout rates among patients with opioid use disorder only versus those with both opioid and stimulant use disorders, and (2) simulate a randomized trial to compare the effects of different opioid agonist medications to treat patients with both opioid and stimulant use disorders. Findings from this research will provide an overview of treatment received by patients with concurrent opioid and stimulant use disorders and also pinpoint the best treatment strategies for these individuals. This research will contribute to the next clinical guideline update for opioid use disorder, better suited to individuals who also use stimulants.