Optimizing patient centered-care: a pragmatic randomized control trial comparing models of care in the management of prescription opioid misuse (OPTIMA Study)
The use of prescription opioid medications (i.e. oxycodone, hydromorphone) has dramatically increased in recent years in Canada, leading to a rise in opioid misuse and related harms such as hospitalization and deaths due to overdose. Thus, the prevention and treatment of opioid addiction has become an urgent public health priority, which requires an evidence-based response that best reflects the needs of patients and their families.
Opioid substitution treatment is widely used to treat prescription opioid addiction. The OPTIMA study will compare and evaluate two such treatments: methadone, which is the current standard of care in Canada, and buprenorphine/naloxone, the therapy of choice in the United States. In order to improve patient care, the study will address real-world treatment conditions, including patient preference for short-term vs. long-term treatment, strict regulations for methadone dosing (i.e. dispensed daily at a pharmacy) vs. flexible take-home dosing for buprenorphine/naloxone, and treatment adherence, among others. The OPTIMA study is designed with the intention to support patient-provider shared decision-making processes in order to increase the number of patients that stay in treatment and improve the success rates of patient-centered approaches. The comparison of the effectiveness of the two treatment models in reducing prescription opioid use will generate practice-based evidence that will be used to inform patient care and improve overall health outcomes.
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