Project 460522

Opioid use and related harms have been steadily increasing in Canada, particularly in the province of Ontario. Thus, opioid use disorder (OUD) is a major public health concern. Opioid agonist treatment (OAT) is the primary pharmacological treatment for OUD in Canada, and is associated with a number of beneficial outcomes including reductions in substance use and overdoses. Individuals who have been stabilized on OAT for a number of months are typically granted access to take-home OAT doses (i.e., carries). However, the decision to grant a patient access to carries is made by prescribers who must use their discretion and make risk/benefit assessments to determine whether patients are capable of adhering to treatment and have proven social, psychological, and economic 'stability'. Based on the subjective nature of these assessments, it is likely that inequities exist regarding whom and under what circumstances a patient becomes eligible for OAT carries. For instance, individuals who cannot 'prove' stability (e.g., homeless individuals, etc.) may experience inequitable access to OAT carries. Furthermore, potential inequities may have been exacerbated or alleviated during the COVID-19 pandemic due to changes in OAT prescribing guidelines and practices. This grant will facilitate a literature review to identify key knowledge gaps pertaining to inequities in access to OAT carries and related policies and establish a network of key stakeholders who will be engaged in two full-day virtual meetings. The outcome of the project will be a report for dissemination among stakeholders, and a full-scale grant application for a study that will examine potential inequities in OAT carry accessibility. This project aligns with the Institute for Health Services and Policy Research's priorities and initiatives, in that it represents the first step towards providing the evidence-base for the equitable provision of OAT carries and thus, improved health service delivery for those with OUD.