Grant: Project Grant

Opioids (e.g. heroin, fentanyl, etc.) acquired in the street and injected in unsafe conditions remain a significant public health challenge. While oral medications such as methadone work well, only approximately 40% of people with opioid use disorder are retained in methadone treatment in their first year. Discontinuing treatment and continuing to inject street opioids leaves people at high risk of HIV, hepatitis C and overdose death. Other opioid agonist treatments exist that can be used instead of methadone, including buprenorphine, morphine, diacetylmorphine, the active ingredient in heroin, and hydromorphone, also known as Dilaudid™. Currently, it is difficult to make an informed decision between treatments, as evidence comparing these treatments to one another is limited. Most trials have compared methadone against alternative opioid treatments. As a result, evidence of the effectiveness of different treatments to one another, for example, buprenorphine compared to morphine or compared to hydromorphone is unknown. While a new trial could answer this question, it would be expensive, complicated to conduct, and take too long to complete to address the current crisis. Instead we propose to use network meta-analysis, a methodology that enables us to synthesize trials to make indirect comparisons of effectiveness between different treatments. Network meta-analysis is routinely used by federal policy makers in Canada to address drugs and technologies, but so far has not been applied to opioid agonist treatments. We will identify all relevant trials to form the 'network', extract their data, and then apply statistical meta-analysis techniques to calculate the results. In addition to publishing the results, in partnership with our study's Knowledge Users and Collaborator, we will produce a simple results info-graphic and an online tool that will provide users with individualized estimates of their risk of outcomes on each of the compared treatments.