Grant: CIHR Fellowship

The opioid epidemic is a critical public health issue in Canada, particularly in British Columbia (BC), where overdose events have surged, exceeding 16,000 in 2023 alone. Individuals with opioid use disorder (OUD) face heightened risks of overdose in the vulnerable period following hospital discharge. Our research indicates that patients who depart the hospital "before medically advised" (BMA) are about ten times more likely to experience an overdose in the first 30 days post-discharge compared to physician-advised discharges. Alarmingly, BMA discharges are three times more frequent among OUD patients and have risen in recent years, yet effective support for these individuals remains scarce. This proposal aims to determine whether initiating opioid agonist therapy (OAT) within seven days after hospital discharge can reduce the risk of overdose among patients with opioid use disorder. We will examine both physician-advised discharges and BMA discharges. OAT, which includes medications like methadone and Suboxone, has been shown to significantly lower drug-related mortality rates. Our study will analyze approximately 180,000 physician-advised and 6,000 BMA discharges using a comprehensive dataset from BC's Provincial Overdose Cohort. We will use a new technique called target trial emulation, which involves applying the principles of a randomized clinical trial to real-world data. By addressing biases through advanced statistical methods, we aim to provide robust evidence on the effectiveness of OAT for improving patient outcomes. Ultimately, this research seeks to inform healthcare practices and policies, potentially leading to better support for individuals at high risk of overdose during the critical post-discharge period.