New national guideline sets out best practices for treating opioid addiction. This guideline strongly recommends opioid agonist treatment with buprenorphine–naloxone as the preferred first-line treatment when possible.
- A new national guideline for the treatment of opioid use disorder has been laid out.
- The guideline highlights the best treatment option for opioid addiction.
- It strongly recommends the use of buprenorphine–naloxone as the preferred first-line treatment.
A new Canadian guideline for managing opioid use disorders lays out the optimal strategies for the treatment of opioid addiction, including recommending opioid agonist treatment with buprenorphine-naloxone as the preferred first-line treatment. The guideline was created for a wide range of health care providers to address an urgent need for evidence-based treatment of opioid use causing overdoses and death. "Opioid use disorder is a public health emergency nationwide and this guideline provides a blueprint for health practitioners to step up and provide evidence-based care," says Dr. Julie Bruneau lead author of the pan-Canadian guideline group and a physician at the Centre Hospitalier de l'Université de Montréal.
"Traditionally, resources for the treatment of opioid addiction have been scarce, and guidelines outlining best practices and practices to avoid have been lacking," says Dr. Evan Wood, senior author and director of the BC Centre on Substance Use at St. Paul's Hospital and the University of British Columbia.
To address the traditional gaps in knowledge in this area, the guideline aims to provide Canadian health care professionals and health authorities with national clinical practice recommendations for treating opioid use disorder. The review panel included 43 health care practitioners with broad experience who are part of the Canadian Institutes of Health Research's Canadian Research Initiative in Substance Misuse (CRISM). The guideline group also involved people with opioid use disorder experience, and considered patient values and preferences in developing its recommendations.
Key recommendations:
- Start opioid agonist treatment with buprenorphine-naloxone whenever possible to reduce the risk of toxicity, illness and death
- In people who respond poorly to buprenorphine-naloxone, consider transitioning to methadone treatment
- Start opioid agonist treatment with methadone when buprenorphine-naloxone is not the preferred option
- In people who respond well to methadone and who want simpler treatment, consider transitioning to buprenorphine-naloxone
- In patients who do not respond to the above therapies, consider slow-release oral morphine, prescribed as daily witnessed doses
- Avoid withdrawal management alone without transition to long-term treatment to reduce the risk of relapse and death.
Beyond recommending best practices, like the use of buprenorphine-naloxone as first-line treatment whenever possible, the guideline also identifies how certain common practices in the Canadian health care system should be avoided, specifically, how offering withdrawal management as an isolated strategy for the treatment of opioid use disorder actually increases rates of overdose.
Opioid use disorder
Opioid use disorder is often a chronic, relapsing condition associated with increased morbidity and risk of death. However, with appropriate treatment and follow-up, individuals can reach sustained long-term remission.
Next steps include increasing education of health care providers about recognizing and managing opioid use disorders and chronic pain, reducing stigma associated with substance use disorders, expanding prescribing access to opioid agonists and expanding access to harm reduction services.
The guideline was funded through the Canadian Research Initiative in Substance Misuse (CRISM), a network funded by the Canadian Institutes of Health Research (CIHR). "Management of opioid use disorders: a national clinical practice guideline" is published March 5, 2018.
References:
- Julie Bruneau, Keith Ahamad et al. Management of Opioid Use Disorders: a National Clinical Practice Guideline, Canadian Medical Association Journal DOI: https://doi.org/10.1503/cmaj.170958
Source-Eurekalert