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Canadian Physicians Release Guidelines for Opioid Use Disorder

Approach forms a blueprint of what the United States could do to curb addiction

A PPM Brief

A newly released Canadian clinical practice guideline1 on managing opioid use disorder (OUD) may offer a template for the United States going forward. Written by a Canadian group of physicians representing the Canadian Research Initiative in Substance Misuse, the guideline aims to provide better education and recommendations for healthcare providers battling the problem. Much like the US, Canada has seen a rise in opioid-related morbidity and death rates due to the introduction of nonmedical opioid usage (eg, heroin and fentanyl), as well as a corresponding increase in hospital admissions and prescription opioid injections.

The authors, led by Julie Bruneau, MD, strongly encourage the use of both opioid agonist treatment, such as buprenorphine-naloxone, in combination with withdrawal management strategies, residential treatment, and psychosocial treatment interventions.1 They note that buprenorphine-naloxone is often used as a first-line treatment due to its safety profile and flexibility as an at-home treatment; while methadone is suggested as a second-line approach, and slow-release morphine with a specialist’s aid tends to be used as a third-line approach if patients do not respond well to or do not prefer the previous treatments. The guideline supports constant adjustment to suit the patient’s needs over time, as a benefit has been shown when using a stepped, integrated care approach that can be adjusted between treatments.1

The application of both opioid agonist treatment and psychosocial interventions at the same time are urged in the guideline due to the lack of success with withdrawal treatment alone, which has been associated with elevated risks of syringe sharing and overdose when compared to no treatment, and relapse when implemented without an accompanying long-term evidence-based treatment.Alternatively, psychosocial intervention and support alone have demonstrated mixed results with opioid withdrawal treatment, stated the authors.1

Commenting on these mixed results from a review of clinical trials, the authors wrote that “collectively, these findings suggest that while information and referrals to psychosocial treatment interventions and supports should be routinely offered, a patient’s decision not to participate in psychosocial treatment interventions should never preclude or delay provision of evidence-based pharmacologic treatments.” Therefore, combined pharmacologic and psychological interventions are recommended in the OUD guideline.

The guideline was influenced by a lack of education and resources available to clinicians to implement an appropriate method to treat patients’ withdrawal symptoms effectively, stated the authors. “The lack of resources dedicated to health care provider education and to overall addiction care, as well as the absence of comprehensive provincial and territorial or national guidelines, have delayed the implementation of evidence-based treatment strategies for opioid use disorder across the addiction care continuum,” they wrote. The physicians concluded the need to urgently expand programs and treatments that may reduce opioid use disorder throughout Canada.1


Last updated on: June 6, 2019
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