Flexible model of care may be effective in treating opioid use disorder


Did you know that more than 26,500 Canadians died from opioid poisoning between January 2016 and September 2021? Or that the more than 350,000 people who have used opioid-containing drugs for pain relief have done so problematically?

In Quebec alone, 339 people died of opioid poisoning between January and September 2021, according to the latest data from the Public Health Agency of Canada.

Today, Canada is one of the largest consumers of opioids in the world, whether medically prescribed or obtained illegally from illicit producers of high-potency substances like fentanyl.

According to a study led by Didier Jutras-Aswad, professor of psychiatry and addiction at the University of Montreal, there is now new evidence that a more flexible model of care than methadone can be as effective in treating disorders related to the use of opioids.

In collaboration with other colleagues involved in the Canadian Research Initiative on Substance Abuse, the clinician-researcher from the CHUM Research Center has published the results of a randomized controlled study in the American Journal of Psychiatry.

Rather than methadone, which must be taken under close pharmacy supervision, their model of care relies on the prescription of buprenorphine-naloxone, known commercially as Suboxone.

Taken home

Study participants were allowed to take Suboxone at home within the first few weeks of treatment. The approach was found to be just as effective as that using methadone, without requiring close supervision.

Until now, studies comparing the effectiveness of these two opioid agonist therapies (OATs) have been conducted under strict medical supervision, considered essential to guarantee the safety and efficacy of the therapies.

Those who receive such treatment often find this approach restrictive – and many more simply don’t get it, as the requirement to be under surveillance limits easy access.

The approach proposed with buprenorphine-naloxone, which is more flexible in many respects than the usual management model with methadone, makes it possible to simplify and facilitate access to OATs on a national scale.”

Didier Jutras-Aswad, Professor of psychiatry and addictology at the University of Montreal

“It’s an additional option, to better accommodate the treatment preferences of people with opioid use disorders and to be more respectful of their autonomy,” he said.

More than 270 attendees

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

With an average age of 39 and one in three women, all had problematic opioid use from prescribed or illegally produced opioids. Among the opioids inventoried were hydromorphone, morphine, oxycodone and fentanyl.

The participants were randomly divided into two groups: half received methadone under close supervision at a pharmacy, and the other half received Suboxone, which could most often be taken at home.

They were followed for 24 weeks in order to compare in particular the effectiveness of each of the treatments in reducing their consumption of opioids.

A latent stigma

Despite calls in recent years for greater awareness of substance use disorders, stigma surrounding people with such issues still hampers access to safe, responsive and evidence-based treatment, Jutras said. -Aswad.

“With the health restrictions and limitations on follow-up visits to healthcare facilities that we have seen during the COVID-19 pandemic, I think we are increasingly realizing that Canadians need treatment options more flexible,” he said.

“We should provide models that better match their needs and situations. This is essential not only to reduce people’s exposure to dangerous opioids, but also to help them improve their health and quality of life.

And while the solution supported by the data from the OPTIMA study is an important part of the response to the opioid and overdose crisis, it absolutely must be part of a broader spectrum of harm reduction strategies to address to these problems, he added.


Research Center of the University of Montreal Hospital Center (CRCHUM)

Journal reference:

Jutras-Aswad, D., et al. (2022) Flexible buprenorphine/naloxone model of care for reducing opioid use in people with prescription opioid use disorder: an open-label, pragmatic, non-inferiority randomized controlled trial. American Journal of Psychiatry. doi.org/10.1176/appi.ajp.21090964.


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