Building Capacity for Injectable Diacetylmorphine and Hydromorphone for the Treatment of Opioid Use Disorder: Identifying Typical Doses

ABSTRACT

Identifying typical doses of existing opioid use disorder medications, such as injectable opioid agonist treatment (iOAT), can support client and program needs, and potentially increase iOAT expansion. Longitudinal data from participants in a cohort study (n = 131), along with clinic dispensation records from August 2014 to April 2020, were used to examine physician prescribed as well as used doses of injectable diacetylmorphine and hydromorphone. Dosage groups, by medication and prescribed dose per session, were created for both hydromorphone and diacetylmorphine. A total of 534, 522 injections were registered during the study period among 129 participants. Mean received diacetylmorphine doses ranged from 106 to 989 mg per day, with most clients using 125–262 mg per session (mean 192.99 mg) and attending 2.40 sessions per day. Mean received hydromorphone doses ranged from 51.09 to 696.06 mg per day, with the majority using 88–154 mg per session (mean 121.32 mg; 2.43 sessions). Average daily doses remained stable overtime and, while mid-range doses were most typical, participants used the whole spectrum of allowable dose prescriptions. Evidence supporting typical doses of iOAT can be integrated into program planning to better allow providers and prescribers to anticipate program needs and engage in individualized care.

KEYWORDS:

• Injectable opioid agonist treatment
• opioid use disorder
• typical doses
• shared-decision making

Acknowledgments

The authors gratefully acknowledge the RUTH study participants for their contributions of time and personal experience. The authors respectfully acknowledge that the land on which the RUTH study took place is the unceded and traditional territory of the Coast Salish Peoples, including the traditional territories of x^w məθkwəýəm (Musqueam), Sḵwxw̱ú7mesh (Squamish), and Səlí̓lwətaɬ (Tsleil-Waututh) Nations. This work was supported by the Canadian Institutes of Health Research Project Grant and Canada Research Chairs.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data that support the findings of this study are available from the corresponding author, EOJ, upon reasonable request.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/02791072.2024.2338734

Additional information

Funding

This work was supported by the Canadian Institutes of Health Research under Grant MOP-142443 and by the Canada Research Chairs.