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, some individuals discontinue treatment and continue injecting street opioids, leaving them at high risk of HIV, hepatitis C and overdose death. Our studies funded by CIHR (NAOMI, SALOME, RUTH) demonstrated that prescribed injectable opioids, i.e. diacetylmorphine, the active ingredient in heroin, and hydromorphone, also known as Dilaudid™, are effective at attracting and retaining such individuals in treatment. Given the present opioid overdose crisis, public health officials are calling for increased access to injectable opioid treatments across Canada. As a result, treatment with injectable opioids will be expanding for the first time in Canada beyond clinical trial participants, to reach individuals who continue to inject illicit street opioids and remain at grave risk of fatal overdose. The PORTIA Study (Program of Outcomes Research on Treatment with Injectables for Addiction) will investigate the expansion of this treatment to new patients who have never received injectable treatment before. As this treatment is expanded to more diverse patients, it is important to explore how patients' with different characteristics (e.g. gender, other drug use, etc.) respond to treatment. Both patient and provider factors will be investigated to help in the design of expanded services that are scalable, feasible, affordable and effective. Our group is the only team in the world to have studied addiction treatment with injectable hydromorphone, and the only one in Canada to have investigated medically prescribed heroin. This study represents a singular opportunity to gather evidence to inform the creation of the most effective programs possible. Expanded access offers the hope of addressing patients' health and social needs and protecting them from the grave risk of overdose.