Grant: Project Grant

Buprenorphine/naloxone (commonly known as Suboxone) is a life-saving medication for people with opioid addiction. Studies show that Suboxone works when started from emergency departments (EDs), which is important because many people make ED visits before they overdose. However, Suboxone is hard to start, because it can cause people to experience bad withdrawal symptoms (vomiting, sweating, pain) if it is started too soon after a person has used other opioids like heroin or morphine. This is called precipitated withdrawal and makes many people afraid of starting Suboxone at all. To prevent this complication, doctors tell patients to wait for 12-24 hours since they last used other opioids and to already be in withdrawal before starting, which is very uncomfortable for patients. A new method, called microdosing, tries to improve patient comfort by avoiding precipitated withdrawal and withdrawal altogether. This method starts people on very small Suboxone doses that gradually increase while they continue to use other opioids. Microdosing has never been evaluated in a formal study. This study will identify adult patients with opioid addiction in EDs in BC and Alberta. We will provide them with either take-home Suboxone microdosing or standard dosing packages to start after they are discharged. We will look at whether patients who receive microdosing are more likely to stay on Suboxone than those who receive a standard dosing package. We will also look at whether people who receive microdosing are more likely to take any opioid agonist therapy in the future, and we will compare deaths, overdoses, and healthcare use between the groups. We are working with health regions, provincial policy makers, public health, and people with lived experience with opioid use to make sure that we share our findings with EDs and patients across Canada. We hope that EDs will use our study results to develop Suboxone programs that are most likely to help patients at risk for overdose.