Grant: Project Grant

Since 2016, there have been over 49,000 opioid-related deaths in Canada. It is estimated that approximately two thirds of individuals who die from an opioid overdose suffer from an addiction to opioids (also known as opioid use disorder). As the unregulated drug supply has become increasingly potent and primarily made up of fentanyl and other adulterants, the usual ways of treating opioid use disorder with methadone and buprenorphine have not been adequate to meet patient and provider needs. Specifically, as a result of highly-potent fentanyl, starting treatment and staying engaged in treatment has been increasingly challenging. To try to address the changing needs of people accessing treatment, the ways in which treatment medications are prescribed has also been changing. These changes include: 1. Low-dose initiation (giving small doses of buprenorphine when starting treatment while the individual continues to use their opioid of choice) 2. New ways of managing consecutive missed doses among individuals on methadone (cancelling the prescription after 4 days rather than 3 days of missed dosing), 3. Increasing use of a long-acting injectable formulation of buprenorphine known as extended-release buprenorphine, and 4. Attempts to taper people from buprenorphine using extended-release buprenorphine. However, owing to the urgent need to adapt treatment delivery, these changes have largely been adopted in the absence of evidence to support their use. The proposed projects therefore aim to understand how often prescribers in Ontario are using the practices above, and whether they are safe and effective. Given the ongoing toxic unregulated drug supply, innovations, including changing prescribing practices, are urgently needed to try to engage people who use opioids in treatment. Through this work, we aim to provide real-world evidence that could shape the treatment of opioid use disorder across Canada and help reduce lives lost to the toxic, unregulated drug supply.