July 2022

An article from our lab, led by Dr. Didier Jutras-Aswad, was published in the American Journal of Psychiatry this month. This publication presents and discusses the most recent data generated through the Optima study, which focuses on the comparison of care models for the management of opioid use.

Specifically, the text discusses about a flexible model of care that is based on using buprenorphine/naloxone. This treatment targets opioid use reduction in individuals with prescription opioid use disorder (POUD).

The study demonstrates that this model of care, which allows the intended clientele to take home doses of buprenorphine/naloxone, is non-inferior to the use of supervised methadone in reducing opioid use among individuals with POUD. The study ran for 24 weeks and included 272 participants aged 18 to 64 years.

Monitored treatment with methadone

Intensive exposure to prescription opioids combined with several factors, such as the pandemic context of COVID-19, has contributed to an increase in estimated opioid mortality, now at 89%.

In order to address this significant increase and reduce the use of these substances, the authors determined that it is important to study and plan an implementation of opioid agonist treatment.

The typical treatment uses methadone, which has a low therapeutic index, in which the difference between therapeutic and toxic doses is small. Therefore, methadone use must be strictly monitored, especially during treatment initiation. This requirement for in-person treatment in specialized clinics, especially in a pandemic context, may demotivate participants to proceed with treatment.

The flexible buprenorphine/naloxone model: is it effective?

Dr. Jutras-Aswad’s team’s paper indicates that buprenorphine/naloxone treatment poses less of a risk at the beginning of treatment, which would allow for earlier implementation of home dosing.

According to the study, participants in the buprenorphine/naloxone usage group were 0.47 times more likely to be maintained in assigned treatment than those in the methadone group.

This model of home care is more flexible, and therefore more acceptable, less costly and better suited to the current context.

There is still room for improvement

The results also show that the overall effectiveness of treatment in a real-life setting is lower than expected. The success rate is particularly low in the context of consumption of very potent opioids (e.g., fentanyl), that are frequently used by people living with a TUO.

The text highlights the importance of developing and testing new and innovative strategies to improve treatment outcomes. A few possible solutions are proposed, such as improving integrated psychosocial interventions, pharmacological treatments and developing new models of care.

To view the article, click here.


June 2022

There is a strong and complex link between opioid dependence and mental health: more than 74% of people living with an opioid use disorder (OUD) develop depression over their lifetime. It is important to address the impact of mental health status in the treatment of OUD in order to increase treatment success and ensure better management of this population. Gabriel Bastien, a PhD student in biomedical sciences, has been interested in this issue for the past two years.

His project focuses on the interrelationship between depression and opioid addiction. Through this study, Gabriel was recently awarded a scholarship from the Neurobiology of Mood Disorders Axis of the Réseau québécois sur le suicide, les troubles de l’humeur et les troubles associés (RQSHA) The $5,000 scholarship was intended to complement the funding of a graduate student member of the RQSHA to support and enhance the development of its research career.

His RQSHA-funded study analyses data taken from the OPTIMA study to assess the impact of depression on the efficacy of opioid agonist treatments, namely methadone and buprenorphine combined with naloxone.

The results of this research project will serve as a tool to help clinicians work with the complex treatment for opioid dependence in the context of comorbid depression. Overall, people living with depression and opioid addiction will have access to improved treatment options tailored to their specific psychiatric disorders and thus, have a greater chance of recovery.

The RQSHA offers four scholarship top-ups for graduate students per year.

  • Clinical Research and Innovative Treatment Interventions Axis (January 15)
  • Neurobiology of Mood Disorders Axis (April 15)
  • Psychosocial, Ethical and Aboriginal Health Research Axis (July 15)
  • Addiction Disorders Axis (October 15)

For more information, visit the RQSHA’s website.