Clinical Resources for Opioid Use Disorder
Despite significant advancements in the province’s system of substance use care, drug poisoning involving opioids continues to be the leading cause of unnatural death in British Columbia, surpassing homicides, suicides, and motor vehicle collisions combined. The primary driver of this ongoing crisis is the rapidly growing toxicity and unpredictability of illegally manufactured and distributed drugs. Higher fentanyl concentrations and novel, dangerous combinations of drugs (e.g., benzodiazepines and fentanyl) have been continually detected in multiple drug surveillance data sources across the province.
This website intends to provide resources for all BC physicians, nursing and allied health professionals, and other care providers involved in the treatment of individuals with opioid use disorder.
Education and training to further support implementation of these and other evidence-informed clinical resources can be found here.
Feb 2026: Unregulated opioids are increasingly adulterated with benzodiazepines, leading to both unintentional and intentional use among individuals who use these substances. As a result, many people may be unaware of their use of benzodiazepines through the unregulated opioid supply. Please see Clinical Bulletin: Benzodiazepine-adulterated Opioids for information relevant to individuals who have developed, or are at risk of developing, benzodiazepine withdrawal following the cessation of unregulated opioid use due to the adulteration of the unregulated opioid supply with benzodiazepines.
A Guideline for the Clinical Management of Opioid Use Disorder (2023)
In response to the escalating drug toxicity crisis, which was also exacerbated by the COVID-19 pandemic, evidence and clinical experience have continued to develop, necessitating updated clinical guidance.
The second edition of the Guideline for the Clinical Management of Opioid Use Disorder, published in November 2023, is intended to reflect this evolution and ensure that health care providers have access to updated clinical guidance aligned with the best available evidence on interventions across the continuum of opioid use disorder care. Accordingly, this updated guideline edition includes information on oral and injectable opioid agonist treatment, antagonist pharmacotherapies, withdrawal management strategies, psychosocial interventions including bed-based treatment programs, harm reduction services and programs, and peer-based support.
July 2024: BC’s Provincial Health Officer issued an order to end the public-health emergency for COVID-19 and rescinding all related orders. This includes the interim clinical guidance Risk Mitigation Guidance in the context of Dual Health Emergencies (RMG).The sunsetting of RMG does not impact prescribing of pharmaceutical alternatives to the unregulated drug supply. Clinical resources for prescribed alternatives include the Opioid Use Disorder Practice Update (2022), Stimulant Use Disorder Practice Update (2022), and fentanyl-related protocols (2023). These resources provide guidance for clinicians considering prescribed alternatives for individuals assessed as being at high risk of toxic drug poisoning.
December 2, 2025: The province has released a new policy for prescribed alternatives. It takes effect on December 30, 2025, and requires prescribed alternatives to be witnessed by health professionals. The BCCSU has developed the Clinical Bulletin Prescribed Alternatives Policy, replacing our Interim Clinical Resource on Prescribed Alternatives.
November 22, 2023: A Guideline for the Clinical Management of Opioid Use Disorder (OUD Guideline) has been updated to provide guidance on the full continuum of OUD care.
Part 1 of the Opioid Use Disorder Practice Update, originally developed to provide updates on the provision of OAT in line with planned updates to the provincial OUD Guideline, is now considered out of date.
In any instances of incongruent guidance between the updated OUD Guideline and the Opioid Use Disorder Practice Update, the guidance contained in the OUD Guideline supersedes the guidance contained in the OUD Practice Update.
Additionally, the 2023 OUD Guideline includes updated guidance relevant to urine drug testing. In any instances of incongruent guidance between the updated OUD Guideline and the UDT Breakout Resource, the guidance contained in the OUD Guideline supersedes the guidance contained in the UDT Breakout Resource.
Key updates related to urine drug testing in the OUD Guideline include:
- No minimum or required number of urine drug tests ordered per year for individuals receiving take-home doses, frequency determined by clinical need
- Urine drug tests for individuals on take-home doses of opioid agonist treatment are not required to be random
- A urine drug test negative for opioids or other substances is not required to be prescribed or to continue take-home doses of opioid agonist treatment
- A urine drug test positive for opioids or other substances alone is not grounds for reducing take-home doses, returning to daily witnessed ingestion, or discontinuing treatment
More information on urine drug testing-related updates can be found in Appendix 6 of the OUD Guideline.
The following are additional Opioid Use Disorder Guideline learning materials for clinicians.
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| OUD Guideline Table of Updates | Principles of Care | Clinical Summary Resources | |
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| Buprenorphine/naloxone | Methadone | Slow-release Oral Morphine | Extended-release Buprenorphine Guidance |
- Providing Care in Acute Care Settings
- Acute Care and Opioid Use Disorder
- Managing Acute Opioid Withdrawal
- Opioid Agonist Treatment Initiation
- Opioid Agonist Treatment Maintenance
- Buprenorphine/naloxone (Suboxone) To Go: Traditional Induction (May 2023)
- Buprenorphine/naloxone (Suboxone) To Go: Low-dose (micro-dosing) Induction (May 2023)
- Buprenorphine/naloxone (Suboxone) To Go: Low-dose (micro-dosing) Induction Wallet-size Dosing Schedule (May 2023)
- Breakout Resource - Urine Drug Testing in Patients Prescribed Opioid Agonist Treatment
- At a Glance - Managing Co-occurring Opioid and Alcohol Use Disorders
- Safer Tablet Injection: A Resource for Clinicians Providing Care to Patients Who May Inject Oral Formulations
- Methadone Chart: Formulation Information, Differences, and Preparation Details
- Clinical Opiate Withdrawal Scale
- DSM-5-TR Criteria for Opioid Use Disorder
- Prescription Checklist for OAT
- Patient Agreement for Take Home Dosing
- Patient Assessment for Opioid Agonist Treatment
- Subjective Opiate Withdrawal Scale (SOWS)
- LOUD in the ED: Emergency Department Buprenorphine/naloxone Induction: Decision Support Tool
Emergency Department Buprenorphine/naloxone Induction
To be used in conjunction with hospital-approved pre-printed order sets for buprenorphine/naloxone induction.
RN/RPN CP-OUD: Methadone and Slow-release Oral Morphine
Decision Support Tool for Registered Nurse (RN) Opioid Use Disorder Certified and Registered Psychiatric Nurse (RPN) Opioid Use Disorder Certified (CP-OUD): Methadone and Slow-release Oral Morphine
RN/RPN CP-OUD: Buprenorphine
Decision Support Tool for Registered Nurse (RN) Opioid Use Disorder Certified and Registered Psychiatric Nurse (RPN) Opioid Use Disorder Certified (CP-OUD): Buprenorphine
The Sublocade product monograph was updated by Health Canada in December 2025, to reflect the addition of on-label prescribing of alternative injection sites and a rapid induction. While CP-OUD DST revisions are in progress to determine CP-OUD RN/RPN clinical decision-making points in relation to these updates, CP-OUD RNs/RPNs are required to consult with an MD/NP to determine a patient’s clinical suitability for alternative injection sites and/or rapid induction.