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Despite the benefits of treatment with medications for opioid use disorder (MOUD), there are limited data on the association between fentanyl, MOUD type and treatment engagement. The objectives of this analysis were to measure the impact of baseline fentanyl exposure on initiation and discontinuation of MOUD among individuals with prescription\u2010type opioid use disorder (POUD).<\/jats:p><\/jats:sec><jats:sec><jats:title>Design, setting and participants<\/jats:title><jats:p>Secondary analysis of a Canadian multi\u2010site randomized pragmatic trial conducted between 2017 and 2020. Of the 269 randomized participants, 65.4% were male, 67.3% self\u2010identified as white and 55.4% had a positive fentanyl urine drug test (UDT) at baseline. Fentanyl\u2010exposed participants were more likely to be younger, to self\u2010identify as non\u2010white, to be unemployed or homeless and to be currently using stimulants than non\u2010fentanyl\u2010exposed participants.<\/jats:p><\/jats:sec><jats:sec><jats:title>Interventions<\/jats:title><jats:p>Flexible take\u2010home dosing buprenorphine\/naloxone or supervised methadone models of care for 24\u2009weeks.<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurements<\/jats:title><jats:p>Outcomes were (1) MOUD initiation and (2) time to (a) assigned and (b) overall MOUD discontinuation. Independent variables were baseline fentanyl UDT (predictor) and assigned MOUD (effect modifier).<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>Overall, 209 participants (77.7%) initiated MOUD. In unadjusted analyses, fentanyl exposure was associated with reduced likelihood of treatment initiation [odds ratio (OR)\u2009=\u20090.18, 95% confidence interval (CI)\u2009=\u20090.08\u20130.36] and shorter median times in assigned [20 versus 168\u2009days, hazard ratio (HR)\u2009=\u20093.61, 95% CI\u2009=\u20092.52\u20135.17] and any MOUD (27 versus 168\u2009days, HR\u2009=\u20093.32, 95% CI\u2009=\u20092.30\u20134.80). The negative effects were no longer statistically significant in adjusted models, and no interaction between fentanyl and MOUD was observed for any of the outcomes (all <jats:italic>P<\/jats:italic>\u2009&gt;\u20090.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Both buprenorphine\/naloxone and methadone may be appropriate treatment options for people with prescription\u2010type opioid use disorder regardless of fentanyl exposure. Other characteristics of fentanyl\u2010exposed individuals appear to be driving the association with poorer treatment outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1111\/add.15954","type":"journal-article","created":{"date-parts":[[2022,6,17]],"date-time":"2022-06-17T07:40:18Z","timestamp":1655451618000},"page":"2662-2672","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":32,"title":["Impact of fentanyl use on initiation and discontinuation of methadone and buprenorphine\/naloxone among people with prescription\u2010type opioid use disorder: secondary analysis of a Canadian treatment trial"],"prefix":"10.1111","volume":"117","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2556-7049","authenticated-orcid":false,"given":"M. Eugenia","family":"Socias","sequence":"first","affiliation":[{"name":"British Columbia Centre on Substance Use  Vancouver BC Canada"},{"name":"Department of Medicine, Faculty of Medicine University of British Columbia  Vancouver BC Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evan","family":"Wood","sequence":"additional","affiliation":[{"name":"British Columbia Centre on Substance Use  Vancouver BC Canada"},{"name":"Department of Medicine, Faculty of Medicine University of British Columbia  Vancouver BC Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernard","family":"Le Foll","sequence":"additional","affiliation":[{"name":"Department of Pharmacology and Toxicology, Faculty of Medicine, Medical Sciences Building University of Toronto  Toronto ON Canada"},{"name":"Department of Family and Community Medicine, Faculty of Medicine University of Toronto  Toronto ON Canada"},{"name":"Department of Psychiatry University of Toronto  Toronto ON Canada"},{"name":"Dalla Lana School of Public Health University of Toronto  Toronto ON Canada"},{"name":"Campbell Family Mental Health Research Institute Center for Addiction and Mental Health (CAMH)  Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ron","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Family Medicine and Psychiatry, Cumming School of Medicine University of Calgary  Calgary AB Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin Cheol","family":"Choi","sequence":"additional","affiliation":[{"name":"British Columbia Centre on Substance Use  Vancouver BC Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wing Yin","family":"Mok","sequence":"additional","affiliation":[{"name":"British Columbia Centre on Substance Use  Vancouver BC Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3484-6456","authenticated-orcid":false,"given":"Julie","family":"Bruneau","sequence":"additional","affiliation":[{"name":"Research Centre Centre Hospitalier de l\u2019Universit\u00e9 de Montr\u00e9al (CRCHUM)  Montr\u00e9al QC Canada"},{"name":"Department of Family and Emergency Medicine, Faculty of Medicine Universit\u00e9 de Montr\u00e9al  Montr\u00e9al QC Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5665-0385","authenticated-orcid":false,"given":"J\u00fcrgen","family":"Rehm","sequence":"additional","affiliation":[{"name":"Department of Psychiatry University of Toronto  Toronto ON Canada"},{"name":"Dalla Lana School of Public Health University of Toronto  Toronto ON Canada"},{"name":"Institute for Mental Health Policy Research, CAMH  Toronto ON Canada"},{"name":"Institute of Clinical Psychology and Psychotherapy Centre and Centre for Clinical Epidemiology and Longitudinal Studies Technische Universit\u00e4t Dresden  Dresden Germany"},{"name":"Department of International Health Projects, Institute for Leadership and Health Management I.M. 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