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Per\u2010protocol (PP): initiating and adhering to the prescribed SROM vs methadone (real\u2010world on\u2010treatment exposure).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements<\/jats:title>\n                    <jats:p>The daily rate of healthcare use\u2014including all\u2010cause and opioid\u2010specific emergency department (ED) visits, all\u2010cause and opioid\u2010specific hospitalization days, all\u2010cause physician encounters\/services, OUD\u2010related physician visits, and non\u2010OUD\u2010related primary care physician visits\u2014over 1\u2009year following treatment prescription or initiation was modelled using weighted modified Poisson regression with generalized estimating equations. Cumulative healthcare use at 1\u2009year and corresponding adjusted rate ratios (aRRs) were estimated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>We identified 3254 unique individuals [median (Q1\u2013Q3) age 37 (30\u201346) years, 64.2% male] contributing to 4059 person\u2010trials (eligible treatment episodes) for the ITT analysis (32.6% SROM) and 1992 unique individuals contributing to 2276 person\u2010trials for the PP analysis (27.4% SROM). ITT analysis shows that receiving a SROM vs. methadone prescription was not associated with statistically significant differences in the rates of all\u2010cause [aRR = 1.10, 95% confidence interval (CI) = 0.997\u20131.20] and opioid\u2010specific ED visits (aRR = 1.00, 95% CI = 0.90\u20131.13), all\u2010cause (aRR = 0.99,\u00a095% CI = 0.81\u20131.18) and opioid\u2010specific hospitalization days (aRR = 0.97, 95% CI = 0.78\u20131.20), all\u2010cause physician encounters\/services (aRR = 1.00, 95% CI = 0.94\u20131.06), OUD\u2010related physician visits (aRR = 0.94, 95% CI = 0.87\u20131.01) and primary care physician visits (aRR = 1.11, 95% CI = 0.98\u20131.24). PP analysis also did not observe statistically significant differences across healthcare outcomes among those who initiated and remained on SROM vs. methadone treatment, with aRRs of 1.24 (95% CI = 0.91\u20131.50), 1.01 (95% CI = 0.67\u20131.36), 1.06 (95% CI = 0.65\u20131.58), 0.95 (95% CI = 0.53\u20131.58), 1.03 (95% CI = 0.90\u20131.17), 0.97 (95% CI = 0.82\u20131.14) and 1.06 (95% CI = 0.73\u20131.46), respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This emulated trial on opioid use disorder patients under a universal healthcare setting in Canada did not observe statistically significant differences in risk of healthcare use outcomes between the patients receiving slow\u2010release oral morphine and those receiving methadone following treatment prescription and initiation. This supports slow\u2010release oral morphine as a viable alternative to methadone with similar real\u2010world effectiveness in preventing all\u2010cause and opioid\u2010related acute healthcare needs and the potential to expand treatment options for opioid use disorder without increasing health system burden.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/add.70543","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T04:17:18Z","timestamp":1784261838000},"page":"3040-3052","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Real\u2010world comparative effects of slow\u2010release oral morphine vs. methadone on healthcare use for opioid use disorder: A population\u2010based target trial emulation"],"prefix":"10.1111","volume":"121","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8964-6259","authenticated-orcid":false,"given":"Vivienne Y.","family":"Zhou","sequence":"first","affiliation":[{"name":"British Columbia Centre on Substance Use  Vancouver Canada"},{"name":"Department of Medicine University of British Columbia  Vancouver Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4195-3284","authenticated-orcid":false,"given":"Nadia","family":"Fairbairn","sequence":"additional","affiliation":[{"name":"British Columbia Centre on Substance Use  Vancouver Canada"},{"name":"Department of Medicine University of British Columbia  Vancouver Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-9632-9777","authenticated-orcid":false,"given":"Jingxin","family":"Lei","sequence":"additional","affiliation":[{"name":"British Columbia Centre on Substance Use  Vancouver Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5248-4639","authenticated-orcid":false,"given":"Rupinder","family":"Brar","sequence":"additional","affiliation":[{"name":"British Columbia Centre on Substance Use  Vancouver Canada"},{"name":"Vancouver Coastal Health Authority  Vancouver Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2413-9133","authenticated-orcid":false,"given":"Paxton","family":"Bach","sequence":"additional","affiliation":[{"name":"British Columbia Centre on Substance Use  Vancouver Canada"},{"name":"Department of Medicine University of British Columbia  Vancouver Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2556-7049","authenticated-orcid":false,"given":"M. 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