Comparative effectiveness of alternative initial doses of opioid agonist treatment for individuals with opioid use disorder: a protocol for a retrospective population-based study using target trial emulation in British Columbia, Canada.

Introduction: Selecting an optimal initial dosage of opioid agonist treatment (OAT) balances effectiveness and safety, as initial doses that are too low may be insufficient, potentially prompting clients to seek unregulated drugs to alleviate withdrawal symptoms, which may increase the likelihood of treatment discontinuation. Conversely, initial doses that are too high carry a risk of overdose. As opioid tolerance levels have risen in the fentanyl era, linked population-level data capturing initial doses in the real world provide a valuable opportunity to refine existing guidance on optimal OAT dosing at treatment initiation.

Comparative effectiveness of urine drug testing schedules alongside opioid agonist treatment: Emulation of a population-based target trial in British Columbia, Canada.

Background And Aim: Urine drug testing is often utilized alongside opioid agonist treatment to assess client progress by validating self-reported substance use, monitoring for diversion and supporting clinical decisions for take-home dosing. However, there is a paucity of evidence to support the practice of urine drug testing. We aimed to determine the association of alternative urine drug testing frequencies with opioid agonist treatment discontinuation, compared with no monitoring, among individuals receiving methadone or buprenorphine/naloxone treatment.

Approaches for Managing Benzodiazepine Dependence Arising From Use of the Adulterated Opioid Supply: A Delphi Technique.

Objectives: Benzodiazepine adulteration of the unregulated opioid supply presents significant clinical challenges, whereby patients can develop physical dependence to benzodiazepines inadvertently. Currently, clinicians lack evidence to guide care of patients potentially experiencing benzodiazepine withdrawal when ceasing use of unregulated opioids. We used a Delphi technique to build consensus around assessment and management of people at risk for benzodiazepine dependence due to the use of unregulated opioids.

Impact of hepatitis C serostatus on health service utilization for opioid-related harms among individuals prescribed opioid agonist therapy: A longitudinal prospective cohort study.

Objectives: Varied substance use outcomes have been reported among individuals with a hepatitis C viral (HCV) infection on opioid agonist treatment (OAT) for opioid use disorder. Accordingly, the current study sought to evaluate the association between HCV serostatus, among other factors, and opioid-related acute health service utilization (e.g.

Comparative effectiveness of maintenance doses of opioid agonist treatment among individuals with opioid use disorder: a target trial emulation protocol using a population-based observational study.

Introduction: Opioid agonist treatment (OAT) prescribing patterns have shifted in recent years in British Columbia (BC), Canada due to the increasingly toxic unregulated drug supply. Experimental evidence to support guidelines on the effectiveness of maintaining clients at different maintenance dosage levels is incomplete and outdated for the fentanyl era. Our objective is to assess the risk of treatment discontinuation and mortality among individuals receiving different maintenance dosage strategies for OAT with methadone, buprenorphine/naloxone or slow-release oral morphine (SROM) at the population level in BC, Canada.

Comparative effectiveness of missed dose protocols of opioid agonist treatment in British Columbia, Canada: protocol for a population-based target trial emulation.

Introduction: Methadone and buprenorphine/naloxone are effective medications for people with opioid use disorder; however, interruptions in daily dosing are common and diminish the benefits of these medications. While clinical guidelines in most North American jurisdictions, including British Columbia (BC), recommend dose adjustment after treatment interruptions to varying levels of specificity, the evidence to support these recommendations is limited. We aim to estimate the comparative effectiveness of alternative dose adjustment strategies on subsequent overdose-related acute care visits and discontinuation of opioid agonist treatment in BC, Canada.

Trends in stimulant use among patients with opioid use disorder receiving substance use treatment: Findings from a prospective cohort study from 2013 to 2020.

Objectives: Despite significant rises in unregulated stimulant use across North America, little is known about the characteristics of stimulant use among individuals with opioid use disorder (OUD). This study sought to describe patterns of stimulant use among a cohort of patients receiving opioid agonist therapy (OAT) from 2013 to 2020.

Methods: A multi-center prospective cohort study (2013-2020) was undertaken to recruit patients > 16 years of age or older with OUD receiving OAT from 57 outpatient treatment centers in Ontario, Canada.

Intravenous Fentanyl for Symptom Management in Hospitalized Patients With Refractory Opioid Withdrawal: A Retrospective Cohort Study.

Objectives: Potent synthetic opioids in the drug supply have resulted in patients with increasingly refractory opioid withdrawal syndromes. This study describes patient characteristics and short-term treatment outcomes for a cohort of hospitalized individuals with opioid use disorder (OUD) treated with intravenous fentanyl for opioid withdrawal.

Methods: A retrospective cohort study of inpatients with fentanyl use disorder and refractory opioid withdrawal, treated with intravenous fentanyl at St.

A protocol for high-dose lisdexamfetamine and contingency management, alone or in combination, for the treatment of methamphetamine use disorder: The ASCME study.

Background: The prevalence of methamphetamine use disorder is increasing in North America. Well-evidenced treatment options are currently limited to behavioural interventions, with contingency management (CM) regarded as the most effective approach. Psychostimulants have been identified as a potentially promising treatment for methamphetamine use disorder, particularly at higher doses.

Comparative effectiveness of methadone take-home dose initiation in British Columbia, Canada: protocol for a population-based retrospective cohort study using target trial guidelines.

Introduction: Due to inferior safety profile and higher risk of diversion than buprenorphine/naloxone, guidelines typically recommend stringent eligibility criteria such as daily witnessed ingestion of methadone for at least 12 weeks before considering take-home doses. Recent research has focused on whether or not to initiate take-home methadone doses, often using pandemic-era data when temporary prescribing changes provided a natural experiment on the impact of access to take-home doses. However, none of these studies adequately examined the optimal timing and criteria for safely starting take-home doses to enhance treatment outcomes.

Association between prescribed stimulant medications and overdose among individuals receiving opioid agonist therapy: A retrospective cohort study from British Columbia, Canada.

Aims: We measured the association between prescribed stimulant medications and overdose among individuals receiving opioid agonist therapy (OAT) for opioid use disorder.

Design: Retrospective cohort study using the British Columbia Provincial Overdose Cohort, a linked administrative database.

Setting: We used data from British Columbia, Canada, from January 2015 through February 2020.

Expanding access to addictions care: Implementation of a 24-hour healthcare provider support line in British Columbia, Canada.

Background: Morbidity and mortality related to substance use have risen to catastrophic levels in North America, and treatment services are often difficult to access. In response, the province of British Columbia (BC), Canada, launched a province-wide addiction medicine support phone line that offers clinicians immediate access to phone consultation with an addictions medicine expert. The service operates 24/7 is accessible to any clinician in the province seeking assistance with an addiction-related question.

Health service utilization, substance use treatment response, and death in patients with opioid use disorder and comorbid hepatitis C findings from prospective cohort study with administrative database linkage.

Background: Among patients with opioid use disorder (OUD), high rates of overdose and death have been reported in subgroups with Hepatitis C Virus (HCV). Evidence on the comorbid effect of HCV on clinical and substance use trajectories has been limited by small sample sizes, short follow-up, and heavy reliance on administrative data which lacks granularity on important prognostic factors. Additionally, few studies include populations on substance use treatment.

Road to Recovery: protocol for a mixed-methods prospective cohort study evaluating the impact of a new model of substance use care in a Canadian setting.

Introduction: The Road to Recovery (R2R) Initiative is an innovative model of substance use care that seeks to increase treatment capacity by creating approximately 100 new addiction treatment beds to provide on-demand addiction care in Vancouver, British Columbia, for patients with substance use disorders. The new model also coordinates the region's existing clinical substance use services to support patients across a care continuum that includes traditional office-based addiction treatment and harm reduction services, early withdrawal management and more intensive abstinence-based treatment programming. To understand the impact of offering on-demand and coordinated substance use care, an observational cohort of individuals who access any R2R clinical service will be created to examine health and social outcomes over time.

Initiation and/or re-initiation of drug use among people who use drugs in Vancouver, Canada from 2021 to 2022: a prospective cohort study.

Objectives: Widespread health service disruptions resulting from the COVID-19 pandemic coincided with a dramatic increase in overdose deaths among people who use drugs (PWUD) in Vancouver, Canada. Those with a history of injection drug use are known to be at heightened risk of substance-associated harms. Drug use patterns and associated sociodemographic and health care utilization trends have been understudied in this population since the pandemic onset.

Opioid agonist treatment outcomes among individuals with a history of nonfatal overdose: Findings from a pragmatic, pan-Canadian, randomized control trial.

Background And Objectives: History of nonfatal overdose (NFO) is common among people who use opioids, but little is known about opioid agonist treatment (OAT) outcomes for this high-risk subpopulation. The objective of this study was to investigate the relative effectiveness of buprenorphine/naloxone and methadone on retention and suppression of opioid use among individuals with opioid use disorder (OUD) and history of NFO.

Methods: Secondary analysis of a pan-Canadian pragmatic trial comparing flexible take-home buprenorphine/naloxone and supervised methadone for people with OUD and history of NFO.

Opioid Coprescription Through Risk Mitigation Guidance and Opioid Agonist Treatment Receipt.

Importance: At the onset of the COVID-19 pandemic, the government of British Columbia, Canada, released clinical guidance to support physicians and nurse practitioners in prescribing pharmaceutical alternatives to the toxic drug supply. These alternatives included opioids and other medications under the risk mitigation guidance (RMG), a limited form of prescribed safer supply, designed to reduce the risk of SARS-CoV-2 infection and harms associated with illicit drug use. Many clinicians chose to coprescribe opioid medications under RMG alongside opioid agonist treatment (OAT).

What is the ideal time to begin tapering opioid agonist treatment? A protocol for a retrospective population-based comparative effectiveness study in British Columbia, Canada.

Introduction: Opioid agonist treatment (OAT) tapering involves a gradual reduction in daily medication dose to ultimately reach a state of opioid abstinence. Due to the high risk of relapse and overdose after tapering, this practice is not recommended by clinical guidelines, however, clients may still request to taper off medication. The ideal time to initiate an OAT taper is not known.