Did you know that over 26,500 Canadians died from opioid intoxication between January 2016 and September 2021? Or that the more than 350,000 people who used opioids to relieve pain had difficulty doing so?

According to the latest figures from the Public Health Agency of Canada, 339 people died from opioid intoxication in Quebec alone between January and September 2021.

Today, Canada is among the largest users of opioids in the world, whether they are prescribed for medical reasons or obtained illegally from illicit manufacturers of highly potent substances such as fentanyl.

Now there is new evidence that a more flexible treatment model than methadone can be just as effective in treating opioid use disorders, according to a study by University of Montreal psychiatry and addiction professor Didier Yutras-Aswad.

Working with other colleagues involved in the Canadian Research Initiative on Substance Abuse, a clinician at the CHUM Research Center published the results of a randomized controlled trial in American Journal of Psychiatry.

Instead of methadone, which must be taken under close supervision in a pharmacy, their treatment model is based on the prescription of buprenorphine-naloxone, known as suboxone.

Taken at home

Study participants were allowed to take Suboxone at home starting in the first weeks of treatment. This approach proved to be as effective as the methadone approach, but without the need for close monitoring.

So far, studies comparing the efficacy of these two opioid agonist (OAT) therapies have been conducted under strict medical supervision, which was considered necessary to ensure the safety and efficacy of the treatments.

Those who are subjected to such treatment often find this approach restrictive, and many others simply do not understand it, as the requirement to be under surveillance limits easy access to it.

“The buprenorphine-naloxone approach, which is more flexible in many ways than the conventional methadone care model, allows us to streamline and facilitate access to OAT at the national level,” Yuthras-Aswad said.

“This is an additional option to better accommodate treatment preferences for people with an opioid use disorder and be more respectful of their autonomy,” he said.

Over 270 participants

For the OPTIMA study, between October 2017 and March 2020, the research team recruited over 270 adult volunteers at seven hospitals and clinics in Quebec, Ontario, Alberta and British Columbia.

With a median age of 39 years and one in three women, all had problems using opioids from either prescription or illicitly manufactured opioids. The opioids registered included hydromorphone, morphine, oxycodone and fentanyl.

Participants were randomly assigned to two groups: half received closely supervised methadone from a pharmacy, and the other half received suboxone, which could most often be taken at home.

They were followed for 24 weeks to particularly compare the effectiveness of each of the treatments in reducing opioid use.

Hidden stigma

Yuthras-Aswad says that despite calls in recent years for greater awareness of substance use disorders, the stigma surrounding people with substance use disorders continues to hinder access to safe, appropriate, and evidence-based treatment.

“With health restrictions and follow-up visit restrictions that we have seen during the COVID-19 pandemic, I think we are becoming more and more aware that Canadians need more flexible treatment options,” he said.

“We have to provide models that are better suited to their needs and situations. This is important not only to reduce people’s exposure to unsafe opioids, but also to help them improve their health and quality of life.”

While a solution supported by OPTIMA data is an important component of the response to the opioid and overdose crisis, it must necessarily be part of a broader range of harm reduction strategies to address these issues, he added.

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