Evidence map›Paper›PMID 37224674›Full record

Trial reportDrug and alcohol dependence2023

Opioid agonist therapy switching among individuals with prescription-type opioid use disorder: Secondary analysis of a pragmatic randomized trial.

Victor Mocanu, Nikki Bozinoff, Evan Wood, Didier Jutras-Aswad, Bernard Le Foll, Ron Lim, Jin Cheol Choi, Wing Yin Mok, M Eugenia Socias, OPTIMA Research Group within the Canadian Research Initiative in Substance Misuse

Open access · greenAbstract readRandomized Controlled TrialMulticenter StudyPragmatic Clinical Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Drug and alcohol dependence, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 1 pooled it
2.6field-weighted citation impact, top 11% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 1 synthesis or guideline pooled it, 9 citations in OpenAlex.

  1. Opioid conversion in adults with cancer: MASCC-ASCO-AAHPM-HPNA-NICSO guideline.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2025
    Guideline
  2. Trial
  3. Observational
  4. Article
  5. Review
  6. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 5 institutions in 1 country.

Victor MocanuBritish Columbia Centre on Substance Use, Vancouver, BC, Canada.
Nikki BozinoffDepartment of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health (CAMH), Toronto, ON, Canada.
Evan WoodBritish Columbia Centre on Substance Use, Vancouver, BC, Canada; Department of Medicine, Faculty of Medicine, University of British Columbia, University of British Columbia, Vancouver, BC, Canada.
Didier Jutras-AswadResearch Centre, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada; Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada.
Bernard Le FollDepartment of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health (CAMH), Toronto, ON, Canada; Department of Pharmacology and Toxicology, Faculty of Medicine, Medical Sciences Building, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Acute Care Program, CAMH, Toronto, ON, Canada.
Ron LimDepartment of Family Medicine and Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
Jin Cheol ChoiBritish Columbia Centre on Substance Use, Vancouver, BC, Canada.
Wing Yin MokBritish Columbia Centre on Substance Use, Vancouver, BC, Canada.
M Eugenia SociasBritish Columbia Centre on Substance Use, Vancouver, BC, Canada; Department of Medicine, Faculty of Medicine, University of British Columbia, University of British Columbia, Vancouver, BC, Canada. Electronic address: bccsu-es@bccsu.ubc.ca.
OPTIMA Research Group within the Canadian Research Initiative in Substance Misuse
British Columbia Centre on Substance Use · CACentre for Addiction and Mental Health · CAUniversity of British Columbia · CACentre Hospitalier de l’Université de Montréal · CAUniversity of Calgary · CA

Funding

Mentoring the next generation of addiction clinician scientists while responding to the opioid epidemicR25DA037756 · NIDA · UNIVERSITY OF BRITISH COLUMBIA · PI FAIRBAIRN, NADIA · 2014 to 2023
$3.6M
NIDA NIH HHS R25 DA037756
6 · The paper itself

Abstract

backgroundEngagement and retention in opioid agonist therapy (OAT) remains a challenge. This study evaluated the impact of initial randomized OAT allocation on subsequent switching among people with prescription-type opioid use disorder (POUD).

methodsSecondary analysis of a 24-week Canadian multicenter, pragmatic, randomized trial conducted between 2017 and 2020 comparing flexible take-home buprenorphine/naloxone versus supervised methadone models of care for POUD. We used Cox Proportional Hazards modeling to assess for impact of treatment assignment on time to OAT switching, adjusting for important confounders. For clinical correlates, we analyzed data from baseline questionnaires on demographic, substance use, and health factors as well as urine drug screen.

resultsOf 272 randomized participants, 210 initiated OAT within 14 days per trial protocol, of whom 103 participants were randomized to buprenorphine/naloxone and 107 to methadone. Within 24-week follow-up, 41 (20.5%) of all participants switched OAT with 25 (24.3%, median 27 days, 88.4 per 100 person-years) and 16 participants (15.0%, median 53.5 days, 46.1 per 100 person-years) switching from buprenorphine/naloxone and methadone arms, respectively. In adjusted analysis, allocation to buprenorphine/naloxone was associated with significantly higher risk of switching (aHR = 2.31, 95% CI 1.22 - 4.38).

conclusionsOAT switching was common in this sample of individuals with POUD, with individuals randomly allocated to buprenorphine/naloxone being more than twice as likely to switch versus methadone. This may reflect a stepped care approach in OUD management. More research is needed to evaluate overall retention and outcomes with the different observed risks of switching between methadone and buprenorphine/naloxone.

Indexed as

BuprenorphineOpioid-Related DisordersAnalgesics, OpioidBuprenorphine, Naloxone Drug CombinationCanadaHumansMethadoneOpiate Substitution TreatmentPrescriptionsAnalgesics, OpioidBuprenorphineBuprenorphine, Naloxone Drug CombinationMethadoneBuprenorphineMethadoneOpioid agonist therapyOpioid use disorderPrescription opioidsRotationSwitching

Identifiers

PMID37224674
PMCPMC12129093
OpenAlexW4376868765

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.