Grant: Doctoral Award - Frederick Banting and Charles Best Canada Graduate Scholarships

Opioid dependence (e.g., heroin) is a chronic illness that poses harms to the individual, their family and the wider community. Oral methadone is the most widely used treatment for opioid dependence. For patients continuing to inject street opioids, evidence suggests that injectable diacetylmorphine (active ingredient in heroin; [DAM]) is an effective alternative. Access to DAM poses regulatory and logistical challenges in Canada and worldwide; thus, there is a need for alternative medications that could attract and retain long-term street opioid injectors not benefitting from conventional treatments. For such contexts, SALOME (Study to Assess Long-term Opioid Medication Effectiveness) tested if hydromorphone (a licensed pain medication; [HDM]) could be an alternative to DAM in a two-stage, randomized, double-blind clinical trial. In Stage I, participants with long-term opioid dependence were randomized to either injectable HDM or DAM. In Stage II half of the participants randomly switched to the oral route of their Stage I medication to test if the oral formulation is as effective as the injectable. Stage II of SALOME was stopped prematurely because of evidence that oral was not as effective as injectable. Despite this, some participants were retained to oral medications and stopped using street opioids. Moreover, some have continued on oral medications since the end of the trial. To determine the effectiveness of these alternative oral medications, this study will analyze the relationship between participant's characteristics and oral treatment access. This study will also meet with a sub-group of participants to collect their perceptions of the effectiveness of oral treatments. This evidence is essential to understand the effectiveness of alternative oral treatments, an approach that could be beneficial for those willing to stop injecting street opioids and not reached by conventional opioid-dependence treatment.