how this vancouver er doctor's study could change how opioid addiction is treated
4 minute read
dr. jessica moe is an emergency doctor at vancouver general hospital and the canada research chair in emergency response to the opioid overdose crisis.
arlen redekop
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a novel strategy for people with opioid use disorder has the potential to transform lives and improve outcomes, and may become standard practice, thanks to a promising new study led by a vancouver emergency room physician.
in the vancouver general hospital er, dr. jessica moe and her colleagues see the losses and feel the impact of the toxic-drug crisis every day.
“health-care providers experience moral distress daily as we witness the devastating societal impact of the toxic-drug crisis firsthand,” said moe, who is also the canada research chair in emergency response to the opioid overdose crisis.
the emergency room is a great equalizer.
“we see patients from every part of society here. opioid use disorder doesn’t discriminate,” said moe.
it’s also the place moe felt would be most helpful for a clinical trial to study the delivery, impact and long-term outcomes of microdosing to initiate buprenorphine treatment for opioid use disorder.
buprenorphine, sold as suboxone, is a synthetic opioid and partial opioid agonist that is a proven replacement therapy, as it reduces dependence on other opioids and helps patients stabilize and have productive lives.
“there is good evidence to support the effectiveness of buprenorphine-naloxone,” said moe. “it’s known to reduce cravings and prevent death. it’s an effective treatment.”
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buprenorphine-naloxone is a tablet that dissolves under the tongue. it’s combined to prevent misuse and diversion, as naloxone prevents users from getting any benefit from crushing or injecting the medication.
the problem is that switching patients from their opioid to buprenorphine-naloxone can cause opioid withdrawal, an extremely painful experience that can cause severe physical symptoms, anxiety and even psychosis.
“fear of withdrawal can be a major barrier to accessing treatment,” said moe. “our study is looking at microdosing as an alternative, using very small doses that slowly and gradually titrate up so people don’t have to go through withdrawal before starting the medication.”
the methodology of microdosing buprenorphine-naloxone in small, but gradually increasing, doses, while patients continue to use other opioids until a replacement level has been reached, is also known as the “bernese method.” it originated in bern, switzerland, and was first reported in scientific journals in 2016.
in 2017, the bernese method was added to the b.c. centre on substance use and ministry of health guidelines in response to the opioid crisis, allowing providers who practice addiction treatment in the province to use the method.
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but there are no practice policy guidelines in place. moe’s study could change that.
her study is the first randomized clinical trial to compare the two methods of starting buprenorphine-naloxone: microdosing and the standard method that forces people to go into withdrawal. it’s also the first study to look at using emergency departments to do targeted screening, and the first to evaluate long-term outcomes and mortality.
the clinical trial is being carried out at four emergency departments, including vancouver general hospital and st. paul’s hospital, and royal alexandra hospital and northeast health centre in alberta.
patients are screened for opioid use disorder, and referred by triage and care providers to moe’s team.
“if people are interested in trying and it’s the right time to do so, we enrol them in the study,” said moe.
participants receive either the five-day microdosing treatment plan or the standard treatment in a take-home bubble pack, and are offered mental-health and social supports.
the emergency department can be that critical place, and moment, where outreach can be successful, said moe. “it is sometimes a turning point in people’s health.”
four hundred participants have completed their treatments so far.
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“i’m very pleased with how it’s going,” said moe, who keeps notes with feedback from patients posted near her workstation.
“their words are what inspire us,” said moe.
one patient moe recalls vividly had come in to the emergency department for a mental-health issue, and disclosed her opioid use. “it had taken hold of her life and gotten in the way of her ability to function and maintain relationships.”
“at a followup within a month of starting the program, she told us that she was being considered for employment, was on a list for housing, and had been reconnecting with friends and family. she was so grateful.”
moe said she hopes the study, which will be completed in 2027, will shape future practice and influence national guidelines for how opioid use disorder is treated.
in canada, opioid-related deaths claimed more than 54,000 lives between january 2016 and december 2024.
“it is imperative that we find new and innovative ways to connect people to care and improve their access to live-saving treatment,” said moe.
for more 世界杯决赛2022 and content around diseases, conditions, wellness, 2022年世界杯名单猜测, drugs, treatments and more, head to healthing.ca – a member of the postmedia network.
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