Personality-Targeted Interventions for Addressing Polysubstance Use among Opioid-Addicted Clients Undergoing Opioid Substitution Therapy: A Feasibility Study

We are currently amid a severe opioid crisis, worsened by the COVID-19 pandemic. In Canada, prescription opioid use and opioid overdoses/mortality were soaring pre-pandemic, reaching epidemic levels, with opioid-related deaths only increasing since the pandemic. Powerful and dangerous synthetic opioids (e.g., Fentanyl) are increasingly being used to cut street drugs given disruptions to the drug supply chain with pandemic border closures. More effective interventions for addressing opioid use disorder are sorely needed. In Canada, an effective mainstay treatment for opioid use disorder is opioid substitution therapy (OST; e.g., methadone, buprenorphine). However, OST clients frequently have other problems that are not well served by OST alone such as high OST drop-out and continued polysubstance use during OST. The latter can include "topping up" with opioids, using substances that are dangerous in combination with OST (e.g., sedatives), and risky routes of administration (e.g., injection). We have recently shown that personality traits that predict risk for mental health/behavioral problems also predict risky forms and routes of substance use in OST clients. We will use our expertise in brief cognitive-behavioral interventions and clinical research methods to test the feasibility of personality-targeted substance use interventions in OST clients. We will use our existing personality model along with interviews already collected and analyzed from OST clients and treatment providers to adapt our personality-targeted interventions. In collaboration with our knowledge user partners, we aim to try 4 personality-targeted interventions with clients across 4 OST clinics, evaluate feasibility, and provide a first test of their impacts on OST clients' polysubstance use and their OST retention. We will examine feasibility from the perspectives of clients, therapists, and clinic directors to see if the personality targeted approach should be pursued further in this population.