Evaluating treatment and employment outcomes in adults with prescription opioid use disorder initiating methadone maintenance or buprenorphine/naloxone opioid agonist therapies in a pan-Canadian pragmatic randomized clinical trial

Since 2016, Canada has been facing a national opioid overdose crisis that continues to have devastating effects on people who use opioids, their families, and communities across the country. Opioid agonist therapies (OATs), such as methadone and buprenorphine/naloxone, are considered first-line treatment options for people with opioid use disorder (OUD) and have shown to reduce overdoses, cravings, and withdrawal symptoms. As a response to the ongoing opioid crisis, researchers with the Canadian Research Initiative on Substance Misuse (CRISM) launched OPTIMA, a 24-week pan-Canadian clinical trial that compared the effectiveness of methadone and buprenorphine-naloxone models among adults with OUD. The OPTIMA trial was conducted between 2017 and 2020 across four provinces in Canada, including British Columbia, where Dr. M Eugenia Socías led as the regional principal investigator. To learn more about the OPTIMA trial, visit here: https://www.optima-trial.com/.
One factor, employment, has shown to have many positive associations for people with OUD, but also present challenges for people on OATs. For instance, methadone typically requires daily attendance at a dispensing pharmacy, which can be a barrier to acquire or sustain employment. On the other hand, buprenorphine-naloxone has a more flexible take-home dosing option, which may improve patient autonomy. However, there is limited research on the differences between different treatment methods. My project aims to evaluate the bidirectional effects of employment and OATs on treatment outcomes among people with OUD, using the data from the OPTIMA trial. This research has been recognized and funded by CANTRAIN-CTTP & Michael Smith Health Research BC (Health Research BC) Master’s Studentship 2023 Award Program. The proposed research aims to further the equitable expansion of evidence-based policies and practices in BC, hopefully contributing to the improvement of addiction care and harm reduction for people who use opioids.

End of Award Update – January 2025

Results

Preliminary analysis revealed that part- or full-time employment is a strong positive factor linked to better treatment retention for individuals starting opioid agonist therapy (OAT) for opioid use disorder. Additionally, we discovered differences in treatment outcomes between methadone and buprenorphine/naloxone, depending on whether individuals were employed or not. These findings provide valuable insights into how employment status influences treatment success. 

Impact & Potential Influence

As this project is ongoing, we hope to engage with key stakeholders, including community organizations, clinicians, and people with lived or living experience, to ensure the findings inform evidence-based practices. By highlighting the connection between employment and treatment outcomes, this research has the potential to advocate for policies that improve addiction care and harm reduction strategies in British Columbia, with broader implications throughout Canada. 

Next Steps

Our next steps include sharing these findings on the relationship between employment and opioid use disorder through conference presentations, plain language summaries, and informational pamphlets targeted at researchers, clinicians, and people with lived or living experience. We also plan to collaborate with stakeholders to develop strategies for knowledge mobilization and advocate for policies and practices that improve both employment and treatment outcomes for people who use opioids.