{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T11:20:50Z","timestamp":1782991250292,"version":"3.54.5"},"reference-count":126,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2025,8,9]],"date-time":"2025-08-09T00:00:00Z","timestamp":1754697600000},"content-version":"unspecified","delay-in-days":8,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000026","name":"National Institutes on Drug Abuse","doi-asserted-by":"crossref","award":["R01DA050629"],"award-info":[{"award-number":["R01DA050629"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,7,21]]},"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Opioid agonist treatment (OAT) prescribing patterns have shifted in recent years in British Columbia (BC), Canada due to the increasingly toxic unregulated drug supply. Experimental evidence to support guidelines on the effectiveness of maintaining clients at different maintenance dosage levels is incomplete and outdated for the fentanyl era. Our objective is to assess the risk of treatment discontinuation and mortality among individuals receiving different maintenance dosage strategies for OAT with methadone, buprenorphine\/naloxone or slow-release oral morphine (SROM) at the population level in BC, Canada.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and analysis<\/jats:title>\n                  <jats:p>We propose a retrospective population-level study of BC residents initiating OAT on methadone, buprenorphine\/naloxone or SROM between 1 January 2010 and 31 December 2022 who were \u226518 years of age with no known pregnancy, no history of cancer diagnosis or receiving palliative care and not currently incarcerated. Our study will employ health administrative databases linked at the individual level to emulate a target trial per OAT type where individuals will be assigned to discrete maintenance dosing strategies, according to the full range observed in BC during the study period. Primary outcomes include treatment discontinuation and all-cause mortality. To determine the effectiveness of alternative maintenance doses, we will emulate a \u2018per-protocol\u2019 trial using a clone-censor-weight approach to adjust for measured time-dependent confounding by indication.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Ethics and dissemination<\/jats:title>\n                  <jats:p>The protocol, cohort creation and analysis plan have been classified and approved as a quality improvement initiative by Providence Health Care Research Ethics Board and the Simon Fraser University Office of Research Ethics. All data are deidentified, securely stored and accessed in accordance with provincial privacy regulations. Results will be disseminated and shared with local advocacy groups and decision-makers, developers of national and international clinical guidelines, presented at national and international conferences and published in peer-reviewed journals electronically and in print.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-098439","type":"journal-article","created":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T04:49:21Z","timestamp":1757393361000},"page":"e098439","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Comparative effectiveness of maintenance doses of opioid agonist treatment among individuals with opioid use disorder: a target trial emulation protocol using a population-based observational study"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-8469-7210","authenticated-orcid":false,"given":"Michelle","family":"Zanette","sequence":"first","affiliation":[{"name":"Centre for Advancing Health Outcomes, Providence Health Care, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0968-722X","authenticated-orcid":false,"given":"Jeong Eun","family":"Min","sequence":"additional","affiliation":[{"name":"Centre for Advancing Health Outcomes, Providence Health Care, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fahmida","family":"Homayra","sequence":"additional","affiliation":[{"name":"Centre for Advancing Health Outcomes, Providence Health Care, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paxton","family":"Bach","sequence":"additional","affiliation":[{"name":"Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada"},{"name":"Department of Medicine, St Paul\u2019s Hospital, Vancouver, British Columbia, Canada"},{"name":"British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M Eugenia","family":"Soc\u00edas","sequence":"additional","affiliation":[{"name":"British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Bruneau","sequence":"additional","affiliation":[{"name":"Centre de Recherche, Centre Hospitalier de l\u2019Universit\u00e9 de Montr\u00e9al, Montreal, Qu\u00e9bec, Canada"},{"name":"Department of Family Medicine and Emergency Medicine, University of Montreal, Montreal, Qu\u00e9bec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P Todd","family":"Korthuis","sequence":"additional","affiliation":[{"name":"Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA"},{"name":"School of Public Health, Oregon Health & Science University-Portland State University, Portland, Oregon, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ehsan","family":"Karim","sequence":"additional","affiliation":[{"name":"Centre for Advancing Health Outcomes, Providence Health Care, Vancouver, British Columbia, Canada"},{"name":"School of Population and Public Health, UBC, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3726-5937","authenticated-orcid":false,"given":"Shaun","family":"Seaman","sequence":"additional","affiliation":[{"name":"MRC Biostatistics Unit, University of Cambridge Institute of Public Health, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikki","family":"Bozinoff","sequence":"additional","affiliation":[{"name":"Campbell Family Mental Health Research Institute; Addictions Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada"},{"name":"Family and Community Medicine, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary Clare","family":"Kennedy","sequence":"additional","affiliation":[{"name":"British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada"},{"name":"School of Social Work, The University of British Columbia Okanagan, Kelowna, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2513-3718","authenticated-orcid":false,"given":"Bohdan","family":"Nosyk","sequence":"additional","affiliation":[{"name":"Centre for Advancing Health Outcomes, Providence Health Care, Vancouver, British Columbia, Canada"},{"name":"Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,8,10]]},"reference":[{"key":"2025081019351202000_15.8.e098439.1","unstructured":"British Columbia Centre on Substance Use, B.C. Ministry of Health . A Guideline for the Clinical Management of Opioid Use Disorder. 2017."},{"key":"2025081019351202000_15.8.e098439.2","unstructured":"British Columbia Centre on Substance Use, BC Ministry of Health, BC Ministry of Mental Health and Addictions . A Guideline for the Clinical Management of Opioid Use, Available: https:\/\/www.bccsu.ca\/opioid-use-disorder"},{"key":"2025081019351202000_15.8.e098439.3","unstructured":"Canadian Research Initiative on Substance Misuse (CRISM) . CRISM National Guideline for the Clinical Management of OPIOID USE DISORDER Canada: Canadian Research Initiative on Substance Misuse (CRISM, 2018. Available: https:\/\/crism.ca\/projects\/opioid-guideline\/"},{"key":"2025081019351202000_15.8.e098439.4","unstructured":"Centre for Addiction and Mental Health . Opioid Agonist Therapy: A Synthesis of Canadian Guidelines for Treating Opioid Use Disorder, 2021. Available: https:\/\/www.camh.ca\/en\/health-info\/guides-and-publications\/canadian-opioid-use-disorder-guideline"},{"key":"2025081019351202000_15.8.e098439.5","unstructured":"Bromley L , Kahan M , Regenstreif L , et al . Methadone treatment for people who use fentanyl: Recommendations: META:PHI, 2021. Available: https:\/\/www.metaphi.ca"},{"key":"2025081019351202000_15.8.e098439.6","unstructured":"American Society of Addiction Medicine . The ASAM National Practice Guideline For the Treatment of Opioid Use Disorder, 2020. Available: https:\/\/www.asam.org\/quality-care\/clinical-guidelines\/national-practice-guideline"},{"key":"2025081019351202000_15.8.e098439.7","unstructured":"Substance Abuse and Mental Health Services Administration (SAMHSA) . Medications for Opioid Use Disorder. Treatment Improvement Protocol (TIP) Series 63, 2021. Available: https:\/\/store.samhsa.gov\/product\/tip-63-medications-opioid-use-disorder\/pep21-02-01-002"},{"key":"2025081019351202000_15.8.e098439.8","unstructured":"California Society of Addiction Medicine . Guidelines for Physicians Working in California Opioid Treatment Programs, 2019. Available: https:\/\/csam-asam.org\/resources\/guidelines-and-publications\/#Guidelines-for-Physicians-Working-in-California-Opioid-Treatment-Programs"},{"key":"2025081019351202000_15.8.e098439.9","unstructured":"Clinical Guidelines on Drug Misuse and Dependence Update 2017 Independent Expert Working Group . Drug misuse and dependence: UK guidelines on clinical management: Global and Public Health \/ Population Health \/ Healthy Behaviours \/ 25460. 2017. Available: https:\/\/www.gov.uk\/government\/publications\/drug-misuse-and-dependence-uk-guidelines-on-clinical-management"},{"key":"2025081019351202000_15.8.e098439.10","unstructured":"National Institute on Health and Care Excellence . Opioid dependence | CKS | NICE. 2022."},{"key":"2025081019351202000_15.8.e098439.11","unstructured":"Gowing L , Ali R , Dunlop A , et al . National Guidelines for Medication-Assisted Treatment of Opioid Dependence, 2014. Available: https:\/\/www.health.gov.au\/resources\/publications\/national-guidelines-for-medication-assisted-treatment-of-opioid-dependence?language=en"},{"key":"2025081019351202000_15.8.e098439.12","unstructured":"Western Australia Community Pharmacotherapy Program, Community Program for Opioid Pharmacotherapy Management Committee . Clinical policies and procedures for the use of methadone and buprenorphine in the treatment of opioid dependence 2014, Available: https:\/\/www.mhc.wa.gov.au\/media\/1614\/wa-clinical-policies-and-procedures-for-the-use-of-methadone.pdf"},{"key":"2025081019351202000_15.8.e098439.13","unstructured":"New South Wales Ministry of Health . NSW Clinical Guidelines: Treatment of Opioid Dependance 2018, Available: https:\/\/www.health.nsw.gov.au\/aod\/Pages\/nsw-clinical-guidelines-opioid.aspx"},{"key":"2025081019351202000_15.8.e098439.14","unstructured":"Ministry of Health . New Zealand Practice Guidelines for Opioid Substitution Treatment New Zealand, 2014. Available: https:\/\/www.health.govt.nz"},{"key":"2025081019351202000_15.8.e098439.15","doi-asserted-by":"publisher","DOI":"10.1001\/jama.194.6.646"},{"key":"2025081019351202000_15.8.e098439.16","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)33078-2"},{"key":"2025081019351202000_15.8.e098439.17","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.m772","article-title":"Opioid agonist treatment and risk of mortality during opioid overdose public health emergency: population based retrospective cohort study","volume":"368","author":"Pearce","year":"2020","journal-title":"BMJ"},{"key":"2025081019351202000_15.8.e098439.18","doi-asserted-by":"publisher","DOI":"10.1111\/acps.13088"},{"key":"2025081019351202000_15.8.e098439.19","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.j1550","article-title":"Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies","volume":"357","author":"Sordo","year":"2017","journal-title":"BMJ"},{"key":"2025081019351202000_15.8.e098439.20","article-title":"Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence","volume":"2014","author":"Mattick","year":"2014","journal-title":"Cochrane Database Syst Rev"},{"key":"2025081019351202000_15.8.e098439.21","doi-asserted-by":"publisher","DOI":"10.1159\/000090423"},{"key":"2025081019351202000_15.8.e098439.22","article-title":"Slow-release oral morphine as maintenance therapy for opioid dependence","volume":"2013","author":"Ferri","year":"2013","journal-title":"Cochrane Database Syst Rev"},{"key":"2025081019351202000_15.8.e098439.23","doi-asserted-by":"crossref","first-page":"832","DOI":"10.1111\/j.1365-2125.2011.03923.x","article-title":"Slow\u2010release oral morphine for opioid maintenance treatment: a systematic review","volume":"71","author":"Jegu","year":"2011","journal-title":"Brit J Clinical Pharma"},{"key":"2025081019351202000_15.8.e098439.24","unstructured":"BC Coroners Service . Unregulated Drug Deaths in B.C. (to Feb. 29, 2024), Available: https:\/\/www2.gov.bc.ca\/gov\/content\/life-events\/death\/coroners-service\/statistical-reports"},{"key":"2025081019351202000_15.8.e098439.25","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1080\/20961790.2019.1588933","article-title":"Novel synthetic opioids - toxicological aspects and analysis","volume":"4","author":"Tabarra","year":"2019","journal-title":"Forensic Sci Res"},{"key":"2025081019351202000_15.8.e098439.26","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/j.neubiorev.2018.12.005","article-title":"Fentanyl: Receptor pharmacology, abuse potential, and implications for treatment","volume":"106","author":"Comer","year":"2019","journal-title":"Neuro Biobehav Rev"},{"key":"2025081019351202000_15.8.e098439.27","doi-asserted-by":"crossref","unstructured":"Baxter LE , Campbell A , DeShields M , et al . Safe Methadone Induction and Stabilization: Report of an Expert Panel. J Addict Med 2013;7. doi:10.1097\/01.ADM.0000435321.39251.d7","DOI":"10.1097\/01.ADM.0000435321.39251.d7"},{"key":"2025081019351202000_15.8.e098439.28","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1111\/dar.13029","article-title":"Opioid agonist treatment in the time of fentanyl: What can we learn from emerging evidence?","volume":"39","author":"Arunogiri","year":"2020","journal-title":"Drug Alcohol Rev"},{"key":"2025081019351202000_15.8.e098439.29","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1097\/ADM.0000000000001356","article-title":"The Impact of High-Potency Synthetic Opioids on Pharmacotherapies for Opioid Use Disorder: A Scoping Review","volume":"18","author":"Jegede","year":"2024","journal-title":"J Addict Med"},{"key":"2025081019351202000_15.8.e098439.30","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.jsat.2017.01.004","article-title":"Characterizing fentanyl use in methadone-maintained clients","volume":"75","author":"Arfken","year":"2017","journal-title":"J Subst Abuse Treat"},{"key":"2025081019351202000_15.8.e098439.31","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1111\/add.16491","article-title":"Prescribing practices in opioid agonist treatment and changes in compliance to clinical dosing guidelines in British Columbia, Canada","volume":"119","author":"Guerra\u2010Alejos","year":"2024","journal-title":"Addiction"},{"key":"2025081019351202000_15.8.e098439.32","unstructured":"Federal Provincial and Territorial Special Advisory Committee on the Epidemic of Opioid Overdoses . Public Health Agency of Canada; Opioid- and Stimulant-related Harms in Canada Ottawa, Ontario, 2023. Available: https:\/\/health-infobase.canada.ca\/substance-related-harms\/opioids-stimulants"},{"key":"2025081019351202000_15.8.e098439.33","unstructured":"National Institute on Drug Abuse, National Center for Health Statistics (NCHS) at the Centers for Disease Control and Prevention . Drug Overdose Death Rates, 2024. Available: https:\/\/nida.nih.gov\/research-topics\/trends-statistics\/overdose-death-rates"},{"key":"2025081019351202000_15.8.e098439.34","unstructured":"Breen P , Smith R . Deaths related to drug poisoning by selected substances, England and Wales. 2023."},{"key":"2025081019351202000_15.8.e098439.35","doi-asserted-by":"crossref","first-page":"104015","DOI":"10.1016\/j.drugpo.2023.104015","article-title":"Monitoring for fentanyl within Australian supervised injecting facilities: Findings from feasibility testing of novel methods and collaborative workshops","volume":"115","author":"Nielsen","year":"2023","journal-title":"Int J Drug Policy"},{"key":"2025081019351202000_15.8.e098439.36","doi-asserted-by":"crossref","first-page":"103573","DOI":"10.1016\/j.drugpo.2021.103573","article-title":"Evaluating how has care been affected by the Ontario COVID-19 Opioid Agonist Treatment Guidance: Patients\u2019 and prescribers\u2019 experiences with changes in unsupervised dosing","volume":"102","author":"Corace","year":"2022","journal-title":"Int J Drug Policy"},{"key":"2025081019351202000_15.8.e098439.37","unstructured":"Lam V , Sankey C , Wyman J . COVID-19 Opioid Agonist Treatment Guidance: META:PHI, Centre for Addiction and Mental Health and Ontario Medical Association (OMA, 2021. Available: https:\/\/www.camh.ca\/-\/media\/health-info-files\/covid-19-2023\/covid-19-modifications-to-opioid-agonist-treatment-delivery-pdf.pdf"},{"key":"2025081019351202000_15.8.e098439.38","doi-asserted-by":"crossref","first-page":"S112","DOI":"10.2105\/AJPH.2021.306654","article-title":"Structural Adaptations to Methadone Maintenance Treatment and Take-Home Dosing for Opioid Use Disorder in the Era of COVID-19","volume":"112","author":"Suen","year":"2022","journal-title":"Am J Public Health"},{"key":"2025081019351202000_15.8.e098439.39","doi-asserted-by":"crossref","first-page":"e238","DOI":"10.1016\/S2468-2667(23)00023-3","article-title":"Synthesising evidence of the effects of COVID-19 regulatory changes on methadone treatment for opioid use disorder: implications for policy","volume":"8","author":"Krawczyk","year":"2023","journal-title":"Lancet Public Health"},{"key":"2025081019351202000_15.8.e098439.40","doi-asserted-by":"crossref","first-page":"109049","DOI":"10.1016\/j.drugalcdep.2021.109049","article-title":"The impact of COVID-19 on opioid treatment programs in the United States","volume":"228","author":"Goldsamt","year":"2021","journal-title":"Drug Alcohol Depend"},{"key":"2025081019351202000_15.8.e098439.41","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.1111\/dar.13382","article-title":"Opioid agonist treatment and patient outcomes during the COVID-19 pandemic in south east Sydney, Australia","volume":"41","author":"Lintzeris","year":"2022","journal-title":"Drug Alcohol Rev"},{"key":"2025081019351202000_15.8.e098439.42","unstructured":"Crawshaw J . Addendum to the New Zealand Practice Guidelines for Opioid Substitution Treatment 2014 Wellington, New Zealand: Ministry of Health, 2014. Available: https:\/\/www.tewhatuora.govt.nz\/assets\/For-the-health-sector\/COVID-19-Information\/COVID-19-\/addendum_to_the_new_zealand_practice_guidelines_for_opioid_substitution_treatment_2014.pdf"},{"key":"2025081019351202000_15.8.e098439.43","unstructured":"Department of Health and Social Care, Public Health England . COVID-19: guidance for commissioners and providers of services for people who use drugs or alcohol, 2021. Available: https:\/\/www.gov.uk\/government\/publications\/covid-19-guidance-for-commissioners-and-providers-of-services-for-people-who-use-drugs-or-alcohol\/covid-19-guidance-for-commissioners-and-providers-of-services-for-people-who-use-drugs-or-alcohol"},{"key":"2025081019351202000_15.8.e098439.44","doi-asserted-by":"crossref","first-page":"104302","DOI":"10.1016\/j.drugpo.2023.104302","article-title":"Adoption of methadone take home policy by U.S. state opioid treatment authorities during COVID-19","volume":"124","author":"Roy","year":"2024","journal-title":"Int J Drug Policy"},{"key":"2025081019351202000_15.8.e098439.45","doi-asserted-by":"crossref","unstructured":"Faggiano F , Vigna-Taglianti F , Versino E , et al . Methadone maintenance at different dosages for opioid dependence. Cochrane Database Syst Rev 2003.:CD002208. doi:10.1002\/14651858.CD002208","DOI":"10.1002\/14651858.CD002208"},{"key":"2025081019351202000_15.8.e098439.46","doi-asserted-by":"publisher","DOI":"10.1111\/add.12333"},{"key":"2025081019351202000_15.8.e098439.47","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-020-06448-z"},{"key":"2025081019351202000_15.8.e098439.48","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwp186"},{"key":"2025081019351202000_15.8.e098439.49","doi-asserted-by":"publisher","DOI":"10.1111\/j.1360-0443.1994.tb00879.x"},{"key":"2025081019351202000_15.8.e098439.50","doi-asserted-by":"publisher","DOI":"10.1080\/00952990802342899"},{"key":"2025081019351202000_15.8.e098439.51","doi-asserted-by":"publisher","DOI":"10.1007\/s00213-002-1027-0"},{"key":"2025081019351202000_15.8.e098439.52","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2019-036102","article-title":"Comparative effectiveness of buprenorphine-naloxone versus methadone for treatment of opioid use disorder: a population-based observational study protocol in British Columbia, Canada","volume":"10","author":"Piske","year":"2020","journal-title":"BMJ Open"},{"key":"2025081019351202000_15.8.e098439.53","doi-asserted-by":"publisher","DOI":"10.1097\/ADM.0000000000001189"},{"key":"2025081019351202000_15.8.e098439.54","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0266142","article-title":"Relative effectiveness of medications for opioid-related disorders: A systematic review and network meta-analysis of randomized controlled trials","volume":"17","author":"Lim","year":"2022","journal-title":"PLoS ONE"},{"key":"2025081019351202000_15.8.e098439.55","unstructured":"Mosd\u00f8l A , Ding KY , Hov L . Alternative Opioid Agonists in the Treatment of Opioid Dependence: A Systematic Review. 2017."},{"key":"2025081019351202000_15.8.e098439.56","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2018-025799","article-title":"Slow release oral morphine versus methadone for the treatment of opioid use disorder","volume":"9","author":"Klimas","year":"2019","journal-title":"BMJ Open"},{"key":"2025081019351202000_15.8.e098439.57","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsat.2014.05.012"},{"key":"2025081019351202000_15.8.e098439.58","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1186\/s13722-022-00299-1","article-title":"Factors associated with retention on medications for opioid use disorder among a cohort of adults seeking treatment in the community","volume":"17","author":"Biondi","year":"2022","journal-title":"Addict Sci Clin Pract"},{"key":"2025081019351202000_15.8.e098439.59","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/j.jsat.2018.08.009","article-title":"Factors associated with methadone maintenance therapy discontinuation among people who inject drugs","volume":"94","author":"Lo","year":"2018","journal-title":"J Subst Abuse Treat"},{"key":"2025081019351202000_15.8.e098439.60","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2016.04.014"},{"key":"2025081019351202000_15.8.e098439.61","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwv254"},{"key":"2025081019351202000_15.8.e098439.62","doi-asserted-by":"crossref","unstructured":"Woo J , Bhalerao A , Bawor M , et al . \u201cDon\u2019t Judge a Book by Its Cover\u201d: A Qualitative Study of Methadone Patients\u2019 Experiences of Stigma. Subst Abuse 2017;11. doi:10.1177\/1178221816685087","DOI":"10.1177\/1178221816685087"},{"key":"2025081019351202000_15.8.e098439.63","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.jsat.2016.03.003","article-title":"The Future of Opioid Agonist Therapies in Ukraine: A Qualitative Assessment of Multilevel Barriers and Ways Forward to Promote Retention in Treatment","volume":"66","author":"Bojko","year":"2016","journal-title":"J Subst Abuse Treat"},{"key":"2025081019351202000_15.8.e098439.64","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1080\/10550887.2022.2088014","article-title":"Factors associated with patient perceived suboptimal dosing of in-hospital opioid agonist therapy among people who use illicit drugs in Vancouver, Canada","volume":"41","author":"El-Akkad","year":"2023","journal-title":"J Addict Dis"},{"key":"2025081019351202000_15.8.e098439.65","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1097\/01.ADM.0000435321.39251.d7","article-title":"Safe methadone induction and stabilization: report of an expert panel","volume":"7","author":"Baxter","year":"2013","journal-title":"J Addict Med"},{"key":"2025081019351202000_15.8.e098439.66","doi-asserted-by":"crossref","first-page":"1727","DOI":"10.1080\/14656566.2016.1209486","article-title":"Buprenorphine dosing choices in specific populations: review of expert opinion","volume":"17","author":"Maremmani","year":"2016","journal-title":"Expert Opin Pharmacother"},{"key":"2025081019351202000_15.8.e098439.67","first-page":"404","article-title":"When \u201cenough\u201d is not enough: new perspectives on optimal methadone maintenance dose","volume":"67","author":"Leavitt","year":"2000","journal-title":"Mt Sinai J Med"},{"key":"2025081019351202000_15.8.e098439.68","unstructured":"British Columbia Ministry of Health . Medical Services Plan (MSP) Payment Information File. 2024. Available: http:\/\/www2.gov.bc.ca\/gov\/content\/health\/conducting-health-research-evaluation\/data-access-health-data-central"},{"key":"2025081019351202000_15.8.e098439.69","unstructured":"British Columbia Ministry of Health . Client Roster, 2024. Available: http:\/\/www2.gov.bc.ca\/gov\/content\/health\/conducting-health-research-evaluation\/data-access-health-data-central"},{"key":"2025081019351202000_15.8.e098439.70","unstructured":"British Columbia Ministry of Health [Publisher] Data Extract MOH . Canadian Institute of Health Information, 2024. Available: http:\/\/www2.gov.bc.ca\/gov\/content\/health\/conducting-health-research-evaluation\/data-access-health-data-central"},{"key":"2025081019351202000_15.8.e098439.71","unstructured":"British Columbia Ministry of Health . National Ambulatory Care Reporting System (NACRS), 2024. Available: http:\/\/www2.gov.bc.ca\/gov\/content\/health\/conducting-health-research-evaluation\/data-access-health-data-central"},{"key":"2025081019351202000_15.8.e098439.72","unstructured":"Perinatal Services BC . British Columbia Perinatal Data Registry. Years Provided: 2000 to 2022, 2024. Available: http:\/\/www2.gov.bc.ca\/gov\/content\/health\/conducting-health-research-evaluation\/data-access-health-data-central"},{"key":"2025081019351202000_15.8.e098439.73","unstructured":"British Columbia Ministry of Health . British Columbia Perinatal Data Registry. Years Provided: 2000 to 2022. Perinatal Services BC, 2024. Available: http:\/\/www2.gov.bc.ca\/gov\/content\/health\/conducting-health-research-evaluation\/data-access-health-data-central"},{"key":"2025081019351202000_15.8.e098439.74","unstructured":"British Columbia Ministry of Health [Publisher] Data Extract MOH . Ministry of Public Safety and Solicitor General (PSSG), 2024. Available: http:\/\/www2.gov.bc.ca\/gov\/content\/health\/conducting-health-research-evaluation\/data-access-health-data-central"},{"key":"2025081019351202000_15.8.e098439.75","unstructured":"British Columbia Ministry of Health [Publisher] Data Extract MOH . British Columbia Ministry of Social Development and Poverty Reduction, 2024. Available: http:\/\/www2.gov.bc.ca\/gov\/content\/health\/conducting-health-research-evaluation\/data-access-health-data-central"},{"key":"2025081019351202000_15.8.e098439.76","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1007\/s00213-012-2833-7","article-title":"Pharmacologic evidence to support clinical decision making for peripartum methadone treatment","volume":"225","author":"Bogen","year":"2013","journal-title":"Psychopharmacology (Berl)"},{"key":"2025081019351202000_15.8.e098439.77","doi-asserted-by":"crossref","first-page":"1250","DOI":"10.1089\/jpm.2020.0409","article-title":"Top Ten Tips Palliative Care Clinicians Should Know About Opioid Use Disorder","volume":"23","author":"Haley","year":"2020","journal-title":"J Palliat Med"},{"key":"2025081019351202000_15.8.e098439.78","first-page":"35","article-title":"Rural, Pregnant, and Opioid Dependent: A Systematic Review","volume":"10","author":"Jumah","year":"2016","journal-title":"Subst Abuse"},{"key":"2025081019351202000_15.8.e098439.79","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1016\/j.ajog.2016.10.003","article-title":"Opioid dependence and pregnancy: minimizing stress on the fetal brain","volume":"216","author":"McCarthy","year":"2017","journal-title":"Am J Obstet Gynecol"},{"key":"2025081019351202000_15.8.e098439.80","doi-asserted-by":"crossref","first-page":"1822","DOI":"10.1001\/jama.2024.16954","article-title":"Buprenorphine\/Naloxone vs Methadone for the Treatment of Opioid Use Disorder","volume":"332","author":"Nosyk","year":"2024","journal-title":"JAMA"},{"key":"2025081019351202000_15.8.e098439.81","doi-asserted-by":"crossref","first-page":"1719","DOI":"10.1093\/ije\/dyaa057","article-title":"Reflection on modern methods: trial emulation in the presence of immortal-time bias. Assessing the benefit of major surgery for elderly lung cancer patients using observational data","volume":"49","author":"Maringe","year":"2020","journal-title":"Int J Epidemiol"},{"key":"2025081019351202000_15.8.e098439.82","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1093\/ije\/dyaa223","article-title":"Versatility of the clone-censor-weight approach: response to \u201ctrial emulation in the presence of immortal-time bias\u201d","volume":"50","author":"Zhao","year":"2021","journal-title":"Int J Epidemiol"},{"key":"2025081019351202000_15.8.e098439.83","doi-asserted-by":"crossref","first-page":"107127","DOI":"10.1016\/j.ypmed.2022.107127","article-title":"To curb research misreporting, replace significance and confidence by compatibility: A Preventive Medicine Golden Jubilee article","volume":"164","author":"Greenland","year":"2022","journal-title":"Prev Med"},{"key":"2025081019351202000_15.8.e098439.84","doi-asserted-by":"crossref","unstructured":"Davison AC , Hinkley DV . Bootstrap methods and their application. Cambridge: Cambridge University Press, 1997.","DOI":"10.1017\/CBO9780511802843"},{"key":"2025081019351202000_15.8.e098439.85","doi-asserted-by":"crossref","first-page":"1258029","DOI":"10.3389\/fpsyt.2023.1258029","article-title":"Optimizing methadone dose adjustment in patients with opioid use disorder","volume":"14","author":"Liu","year":"2023","journal-title":"Front Psychiatry"},{"key":"2025081019351202000_15.8.e098439.86","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.0030080","article-title":"Determining Effective Methadone Doses for Individual Opioid-Dependent Patients","volume":"3","author":"Trafton","year":"2006","journal-title":"PLoS Med"},{"key":"2025081019351202000_15.8.e098439.87","unstructured":"British Columbia Centre on Substance Use . COVID-19: Information for Opioid Agonist Treatment Prescribers and Pharmacists 2020, Available: https:\/\/www.bccsu.ca\/wp-content\/uploads\/2020\/05\/COVID-19-Bulletin-May-20-2020.pdf"},{"key":"2025081019351202000_15.8.e098439.88","unstructured":"Oetter HM . COVID-19: Important update from the registrar: College of Physicians and Surgeons of British Columbia, 2020. Available: https:\/\/www.cpsbc.ca\/files\/pdf\/2020-03-24-COVID-19-Update-from-the-Registrar.pdf"},{"key":"2025081019351202000_15.8.e098439.89","unstructured":"College of Pharmacists of British Columbia . Changes to the Delivery Requirements for OAT Now In Effect 2020, Available: https:\/\/www.bcpharmacists.org\/news\/changes-delivery-requirements-oat-now-effect"},{"key":"2025081019351202000_15.8.e098439.90","unstructured":"British Columbia Centre on Substance Use . Prescribed Alternatives, 2025. Available: https:\/\/www.bccsu.ca\/clinical-care-guidance\/prescribed-alternatives"},{"key":"2025081019351202000_15.8.e098439.91","unstructured":"BC Centre on Substance Use . Risk Mitigation in the Context of the Dual Public Health Emergencies, 2020. Available: https:\/\/www.homelesshub.ca\/resource\/risk-mitigation-context-dual-public-health-emergencies-interim-clinical-guidance"},{"key":"2025081019351202000_15.8.e098439.92","unstructured":"Ministry of Mental Health and Addiction, Ministry of Health . Access to Prescribed Safer Supply in British Columbia: Policy Direction. 2021."},{"key":"2025081019351202000_15.8.e098439.93","doi-asserted-by":"crossref","DOI":"10.1136\/bmj-2023-076336","article-title":"Effect of Risk Mitigation Guidance for opioid and stimulant dispensations on mortality and acute care visits during dual public health emergencies: retrospective cohort study","volume":"384","author":"Slaunwhite","year":"2024","journal-title":"BMJ"},{"key":"2025081019351202000_15.8.e098439.94","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.drugpo.2018.06.003","article-title":"Developing a patient-reported experience questionnaire with and for people who use drugs: A community engagement process in Vancouver\u2019s Downtown Eastside","volume":"59","author":"Olding","year":"2018","journal-title":"Int J Drug Policy"},{"key":"2025081019351202000_15.8.e098439.95","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2007.11.008"},{"key":"2025081019351202000_15.8.e098439.96","unstructured":"Indivior UK Limited and Pharma Importing Inc . Product Monograph: Suboxone Toronto, ON. 2017. Available: https:\/\/pdf.hres.ca\/dpd_pm\/00041074.PDF"},{"key":"2025081019351202000_15.8.e098439.97","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2021.17128","article-title":"High-Dose Buprenorphine Induction in the Emergency Department for Treatment of Opioid Use Disorder","volume":"4","author":"Herring","year":"2021","journal-title":"JAMA Netw Open"},{"key":"2025081019351202000_15.8.e098439.98","doi-asserted-by":"publisher","DOI":"10.1111\/j.1360-0443.2005.01232.x"},{"key":"2025081019351202000_15.8.e098439.99","doi-asserted-by":"publisher","DOI":"10.1001\/jama.281.11.1000"},{"key":"2025081019351202000_15.8.e098439.100","doi-asserted-by":"publisher","DOI":"10.1080\/02791072.1999.10471730"},{"key":"2025081019351202000_15.8.e098439.101","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)60349-2"},{"key":"2025081019351202000_15.8.e098439.102","unstructured":"Methadose oral concentrate: US Food and Drug Administration, 2008. Available: https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2008\/017116s021lbl.pdf"},{"key":"2025081019351202000_15.8.e098439.103","unstructured":"Department of Veterans Affairs, Department of Defense . VA\/DoD clinical practice guideline for the management of substance use disorders, 2021. Available: https:\/\/www.healthquality.va.gov\/guidelines\/MH\/sud\/VADoDSUDCPGProviderSummary.pdf"},{"key":"2025081019351202000_15.8.e098439.104","doi-asserted-by":"publisher","DOI":"10.1007\/s002130000623"},{"key":"2025081019351202000_15.8.e098439.105","doi-asserted-by":"publisher","DOI":"10.1037\/1064-1297.10.1.39"},{"key":"2025081019351202000_15.8.e098439.106","first-page":"66","article-title":"Buprenorphine: Dose-related effects on cocaine and opioid use in cocaine-abusing opioid-dependent humans","volume":"34","author":"Schottenfeld","year":"1993","journal-title":"Biol Psychiatry Cogn Neurosci Neuroimaging"},{"key":"2025081019351202000_15.8.e098439.107","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1016\/S0022-3565(25)10510-7","article-title":"Acute administration of buprenorphine in humans: partial agonist and blockade effects","volume":"274","author":"Walsh","year":"1995","journal-title":"J Pharmacol Exp Ther"},{"key":"2025081019351202000_15.8.e098439.108","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0132664","article-title":"Identifying Homelessness among Veterans Using VA Administrative Data: Opportunities to Expand Detection Criteria","volume":"10","author":"Peterson","year":"2015","journal-title":"PLoS ONE"},{"key":"2025081019351202000_15.8.e098439.109","unstructured":"BC Centre for Disease Control . Chronic Disease Dashboard: Case Definitions 2020, Available: http:\/\/www.bccdc.ca\/health-professionals\/data-reports\/chronic-disease-dashboard#Case--Definitions"},{"key":"2025081019351202000_15.8.e098439.110","doi-asserted-by":"crossref","DOI":"10.1186\/s12888-016-0963-x","article-title":"Can mental health diagnoses in administrative data be used for research? A systematic review of the accuracy of routinely collected diagnoses","volume":"16","author":"Davis","year":"2016","journal-title":"BMC Psychiatry"},{"key":"2025081019351202000_15.8.e098439.111","doi-asserted-by":"publisher","DOI":"10.1177\/070674371506000805"},{"key":"2025081019351202000_15.8.e098439.112","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.170453"},{"key":"2025081019351202000_15.8.e098439.113","doi-asserted-by":"crossref","first-page":"591","DOI":"10.2147\/CEOR.S108288","article-title":"Disease progression and health care resource consumption in patients affected by hepatitis C virus in real practice setting","volume":"8","author":"Perrone","year":"2016","journal-title":"Clinicoecon Outcomes Res"},{"key":"2025081019351202000_15.8.e098439.114","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2018.07.008"},{"key":"2025081019351202000_15.8.e098439.115","doi-asserted-by":"publisher","DOI":"10.1097\/01.mlr.0000182534.19832.83"},{"key":"2025081019351202000_15.8.e098439.116","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2009.05.021"},{"key":"2025081019351202000_15.8.e098439.117","doi-asserted-by":"publisher","DOI":"10.1136\/amiajnl-2013-001856"},{"key":"2025081019351202000_15.8.e098439.118","doi-asserted-by":"crossref","unstructured":"Tonelli M , Wiebe N , Fortin M , et al . Methods for identifying 30 chronic conditions: application to administrative data. BMC Med Inform Decis Mak 2016;15. doi:10.1186\/s12911-015-0155-5","DOI":"10.1186\/s12911-015-0155-5"},{"key":"2025081019351202000_15.8.e098439.119","unstructured":"Centers for Disease Control and Prevention . Alcohol-Related ICD Codes 2020, Available: https:\/\/www.cdc.gov\/alcohol\/ardi\/alcohol-related-icd-codes.html"},{"key":"2025081019351202000_15.8.e098439.120","unstructured":"Centers for Disease Control and Prevention . Alcohol-Related ICD Codes 2020, Available: https:\/\/caiglobal.org\/wp-content\/uploads\/2023\/06\/documenting-coding-billing-for-tobacco-dependence-treatment-hsi.pdf"},{"key":"2025081019351202000_15.8.e098439.121","unstructured":"University of Manitoba . Concept: Charlson Comorbidity Index 2021, 2021. Available: http:\/\/mchp-appserv.cpe.umanitoba.ca\/viewConcept.php?conceptID=1098"},{"key":"2025081019351202000_15.8.e098439.122","unstructured":"Government of British Columbia . Alternative Payments Program, Available: https:\/\/www2.gov.bc.ca\/gov\/content\/health\/practitioner-professional-resources\/physician-compensation\/alternative-payments-program"},{"key":"2025081019351202000_15.8.e098439.123","unstructured":"Provincial Health Services Authority . Identifying determinants for hospitalization based on healthcare utilization records, 2008. Available: http:\/\/www.bccdc.ca\/pop-public-health\/Documents\/Identifying%20determinants%20for%20hospitalization%20based%20on%20healthcare%20utilization%20records%20%282008%29.pdf"},{"key":"2025081019351202000_15.8.e098439.124","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1186\/s13012-023-01331-x","article-title":"Influence of physician networks on the implementation of pharmaceutical alternatives to a toxic drug supply in British Columbia","volume":"19","author":"Kurz","year":"2024","journal-title":"Implementation Sci"},{"key":"2025081019351202000_15.8.e098439.125","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1097\/ADM.0000000000000156","article-title":"Evaluating the Effectiveness of First-Time Methadone Maintenance Therapy Across Northern, Rural, and Urban Regions of Ontario, Canada","volume":"9","author":"Eibl","year":"2015","journal-title":"J Addict Med"},{"key":"2025081019351202000_15.8.e098439.126","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsat.2017.07.001"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2024-098439","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T04:50:02Z","timestamp":1757393402000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2024-098439"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8]]},"references-count":126,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2025,8,10]]},"published-print":{"date-parts":[[2025,8]]}},"alternative-id":["10.1136\/bmjopen-2024-098439"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2024-098439","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8]]}}}