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

Canada is in the midst of a public health crisis of opiod-related overdoses that resulted in approximatley 7000 overdose deaths from 2016 to 2017. This crisis highlights a growing trend of opioid use disorder, and urgent need to scale up and effectively implement medication-based treatments (e.g. Methadone, Suboxone, slow releasese oral morphine and injectible opioid agonist treatments) to improve the health outcomes of this population. Recently, a number of best practice guidelines have been developed, and policy changes implemented, that make it easier for health care providers to deliver these treatments in response to persistent gaps in treatment enrollment and retention. Importantly, evidence-based guidelines recommend a continuum of medication-based treatment options for opioid use disorder tailored to individual needs, including primary (Suboxone), secondary (Methadone), and tertiary (Slow Release Oral Morphine and/or injectable opioid agonist treatments (e.g. hydromorphone)) options. To date, there is a poor understanding of the social-structural factors that influence how patients initiate treatment; adhere to treatment, and transition between treatment options, as well as subsequent impacts on overdose-related outcomes. This study will use an ethnographic approach in order to characterize these social-structural factors and identify further gaps in the implementation of treatment for people with opioid use disorder. Patient interviews, ethnographic observations, and a patient chart reviews will be conducted in order to develop an in-depth understanding of treatment implementation. This study will contribute to the overdose response by indicating ways that the provision of treatment for opioid use disorder can be optimized and in turn contribute to a concerted public health response to the ongoing crisis.