A simpler, less invasive treatment for opioid abuse appears to be just as effective as traditional treatments like methadone, according to new research from the Canadian Research Initiative in Substance Misuse. 

Currently, patients might be asked to come to the pharmacy every day for two or three months as part of their initiation of methadone or morphine therapy.

"It takes a high level of motivation to follow these treatments," said Dr. Didier Jutras-Aswad, a psychiatrist at the Université de Montréal hospital (CHUM) and one of the study authors. "But we also have people who were very motivated [...] but who did not want to embark on this type of treatment knowing that it's so demanding."

The research, published in the American Journal of Psychology, suggests it's possible to offer these patients a more flexible treatment without reducing the chances of success.

This treatment is based on the use of buprenorphine-naloxone, also known by the trade name Suboxone, which can usually be taken from home.

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

The average age of the participants, about two-thirds of whom were men, was 39. They all had a history of using prescription or illegally produced opioids, such as hydromorphone, morphine, oxycodone or fentanyl.

Subjects were randomly divided into two groups. One was given methadone, supervised in a pharmacy, and the other was given Suboxone.

Participants were followed for 24 weeks to compare the effectiveness of each treatment in reducing their opioid use.

"[Suboxone] is a little less potent than methadone and is associated with a lower risk of overdose," said Jutras-Aswad. "We relied on the safety profile of buprenorphine, which is advantageous, to test a model of care where we would reduce the supervision load -- the intensity of direct supervision at the beginning of treatment."

The recommendation was that after the first two weeks of treatment, the patient could take up to one week of unsupervised doses at home, which involves a single visit to the pharmacy. After two weeks, it was recommended these visits be further spaced out, at a rate of two per month.

The study's goal, Jutras-Aswad said, was to determine whether a much more flexible model of care, with much less supervision, would be just as effective in reducing substance use as the usual methadone model.

"Our study showed us that buprenorphine [...] was non-inferior to methadone treatment," he said, adding that there's "a tendency for buprenorphine to be even slightly more effective than methadone."

"It's no small thing to have to go to the pharmacy every day," said Jutras-Aswad. "I think it's really a win-win model [...] that really helps address a situation that is catastrophic."

The Public Health Agency of Canada reports more than 5,300 Canadians died from an opioid overdose between January and September of 2021, which amounts to about 20 deaths per day.

In Quebec alone, that number was 339.

This report was first published in French by The Canadian Press on June 15, 2022.