Treatment of Opioids in Psychosocial and Recovery-based Programs (TOPP)

PI: David Hodgins (University of Calgary, AB)

Leadership Group: Barney Savage (Addictions and Mental Health Ontario, ON); Cam Wild (University of Alberta, AB); Lena Quilty (CAMH, ON); Lois Jackson (Dalhousie University, NS); Marshall Smith (BCCSU, BC); Simon Debreucq (CHUM, QC)

 This project theme addresses the issue that there are “two worlds” of treatment services for opioid use disorder: specialized addiction treatment and recovery services that provide a variety of psychosocial interventions across a range of settings (outpatient, day programs, residential programs) and opioid antagonist treatments (OAT) that provide methadone and/or buprenorphine in medical services.  Individuals in some communities can access either or both of these options, whereas many other communities have limited access to OAT. Until recently, these two worlds operated largely independently, but the opioid crisis has both increased recognition of the gap between these models and has facilitated a shift toward integration in some areas of the country. However, at present we do not have a fulsome, comprehensive understanding of the current status of the treatment of opioid use disorder within the psychosocial treatment system.

The Treatment of Opioids in Psychosocial Programs (TOPP) project will survey the range of current approaches to the treatment of individuals with opioid use disorder within psychosocial addiction treatment programs across Canada. Through the survey and from stakeholder input, examples of model programs with safe and effective approaches to the treatment of opioid use disorder will be identified and “good practice” descriptions will be developed through key informant interviews and in-depth case study. These models will include OAT integrated, collaborative, and supportive programs as well as programs providing only psychosocial treatment.

The survey results and model programs will provide the basis for developing an intervention plan for improving the treatment of individuals with dependence, based upon services gaps, attitudes, barriers, and the perceived needs of programs. The implementation of this plan will be conceptualized and assessed using the Consolidated Framework for Implementation Research in order to maximize its reach, immediate impact, and longer-term value in future program development.

Objectives include:

  • Developing a comprehensive understanding of how opioid use disorder is treated currently in psychosocial addiction treatment and recovery programs across Canada,
  • Identifying types of outcomes (if any) routinely collected to document effectiveness of the treatment of individuals with opioid use disorder in psychosocial treatment and recovery programs,
  • Describing attitudes and philosophical beliefs of psychosocial treatment providers towards OAT and other harm reduction interventions,
  • Describing the current use of OAT within these programs as well as support for clients wishing to use OAT concurrently with their involvement in psychosocial programs,
  • Describing perceived program-level and individual-level barriers towards integrated OAT-psychosocial treatment,
  • Identifying current gaps or perceived needs in psychosocial treatment and recovery programs for opioid use disorder,
  • Identifying best practice model program descriptions,
  • Developing of an implementation plan to increase uptake of best practice and evaluate its impact.