Grant: CIHR Fellowship

Overdose death rates have increased dramatically in Canada in recent years. These deaths have been driven largely by the inadvertent use of powerful opioids, including fentanyl, that have been added to street drugs such as heroin. In British Columbia (BC), a record number of overdose deaths led the provincial government to declare a public health emergency in 2016. Strategies to address the overdose crisis have therefore become an urgent public health priority. One such strategy that has recently been introduced in BC is the expansion of treatment options for opioid use disorder, including injectable treatments. Previous research conducted under idealized clinical conditions has found that such treatments may be beneficial for individuals with opioid use disorder who have not had success with oral treatments such as methadone. However, little is known about the effectiveness of injectable treatments for opioid use disorder under "real world" conditions. This is an important gap in understanding given that medications found to be effective under idealized conditions often perform differently once translated to real world populations and general practice settings. The proposed research will use prospective methods to monitor and evaluate the uptake and impacts of injectable opioid treatments as these are expanded in BC. Specifically, this research aims to identify barriers and facilitators to access to and retention on injectable treatments, as well as how retention in these treatments shapes health outcomes, including reductions in drug use and risk of overdose. This project will also seek to determine how healthcare models of injectable treatment delivery (e.g., pharmacy models; health clinic models) can be best adapted to address the needs of different populations of patients. It is hoped that the proposed research will make important contributions to understanding and improving treatment for opioid use disorder, both in Canada and internationally.