The Québec Journey Towards Injectable Treatment for Opioid Use Disorders
The efficacy of oral opioid agonist treatments such as methadone or buprenorphine-naloxone for opioid use disorders has been demonstrated in terms of treatment retention, ceasing or reducing illicit opioid use, a reduction in mortality and morbidity and reduction in the risk of contracting HIV and hepatitis C for those who use injection methods of administration. However, a proportion of people with severe opioid use disorders are not attracted to or retained by conventional oral treatments. In order to expand the treatment offer, the prescription of injectable opioids to treat opioid use disorders can be considered for patients who are not responding to usual treatment methods. In Quebec, the conditions supporting the expansion of the current treatment offer through the implementation of an injectable opioid prescription program are related to: 1) the scientific demonstration of treatment efficacy in Canada and Europe, 2) legislation changes at the federal level in Canada, 3) the support from the Quebec provincial government and 4) the organization of local services. At the time of writing this article, these conditions are in place. In terms of scientific data, research programs in Canada and Europe have demonstrated the efficacy of injectable opioid agonist treatment. Legally, federal legislative changes paved the way for provinces to implement injectable treatment. In terms of political support in the province of Québec, funding for the feasibility study on injectable opioid agonist treatment by the Ministry of Health and Social Services highlights political support for its implementation. At the local level, at least one treatment facility is currently implementing the necessary conditions to provide injectable treatment in Montréal.