Buprenorphine/Naloxone Microdosing Clinical Trial Launches

Dr. Jessica Moe and her team are excited to announce the official launch of their study, “Evaluating Microdosing in the Emergency Department: A randomized controlled trial of buprenorphine/naloxone microdosing vs. standard dosing” (The EMED Study) on July 23, 2021 at Vancouver General Hospital.

Background to the Study

This study builds off of a feasibility study conducted at Vancouver General Hospital from July 2019 to March 2020: Microdosing and standard-dosing take-home buprenorphine from the emergency department: A feasibility study.

The Vancouver General Hospital is the site of the largest study to date on microdosing and the only one conducted in an emergency department setting.

Why is this study needed?

  • A majority of people present to emergency departments before overdosing. Sadly, many opportunities to engage with them and offer life-saving opioid agonist therapies are currently missed.
  • Buprenorphine/naloxone is effective and safe when started from emergency departments.
  • Many people cannot tolerate withdrawal required for standard inductions and some specifically request microdosing. Microdosing involves starting smaller doses without requiring withdrawal. It aims to improve patient comfort; however, it has not been studied and the emergency department regimen will involve overlap with illicit opioid use. Equipoise exists regarding the best method.
  • Overdose deaths have risen to historic highs since COVID-19: 1,724 people died from overdose in British Columbia in 2020 compared to 985 deaths in 2019.

Overview of the Study

This is a multicenter randomized controlled trial evaluating take-home bubble packs of buprenorphine/naloxone microdosing and standard dosing for people with opioid use disorder identified in emergency departments. The Team is assessing whether induction method is more effective at retaining people on buprenorphine/naloxone or other opioid agonist therapies.

This study will also roll-out at three other emergency department sites in the next year:

  • Vancouver, BC: St. Paul’s Hospital (Site PI: Dr. Andrew Kestler) – Fall 2021
  • Edmonton, AB: Royal Alexandra Hospital (Site PI: Dr. Kathryn Dong) – Winter 2021
  • Edmonton, AB: North East Community Health Centre (Site PI: Dr. Robert Wittmeier) – Winter 2021

Questions, Comments or Concerns?

Dr. Moe and team welcome any and all input on how they can make their study most relevant to emergency departments across British Columbia!

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