Made-in-BC approach model for new national guideline for treating opioid use disorder

published on March 5, 2018

A first of its kind Canadian guideline setting out best practices for treating people with opioid addiction has been released today. The new guideline, based on provincial guidelines developed by the BC Centre on Substance Use (BCCSU) and implemented in British Columbia last year, will support health care providers to help address overdoses and save lives.

The new guideline provides evidence-based recommendations a range of therapeutic options for the optimal treatment of opioid use disorder.

Since the releasing the guideline, the Province has, through the BCCSU, increased educational resources for health care providers to help recognize and manage opioid use disorders and expanded prescribing access to medications, known as opioid agonist treatment.

“It is critical that people living with opioid addiction have access to lifesaving prescription medication,” said Judy Darcy, Minister Mental Health and Addictions. “It is only if we help people stay alive that we can connect them to treatment, recovery and social supports and create a pathway to hope.”

Last year, the BCCSU trained more than 2,000 health care providers across the province on how to deliver evidence-based treatments to people with opioid use disorder. Additionally, the BCCSU launched the new no-cost online-based Addiction Medicine Diploma to train prescribers in best practices for treating opioid use disorder. More than 800 prescribers have enrolled in the course since July.

Canada has been significantly impacted by the overdose emergency with over 4,000 deaths between January 2016 and June 2017. In British Columbia, more than 1,400 lives were lost to overdose in 2017. Opioid agonist treatment is an evidenced-based maintenance treatment that can help a person stabilize. Since June 2017, when the guidelines came into effect, more than 27,500 patients in B.C. have received opioid agonist treatment. Prior to the guidelines, there were 22,700 patients receiving treatment. Additionally, the number of active opioid agonist treatment prescribers in the province increased from 853 to 1,365, approximately 60 percent, after the release of the guidelines.

“There has been a long-standing need in Canada for evidence-based guidelines for treating substance use disorders, which has become more urgent in the midst of an epidemic of opioid overdoses,” said Dr. Evan Wood, Director of the BCCSU and senior author of the new national guideline. “British Columbia has led the way in establishing a blueprint for health practitioners and developing support tools to ensure they’re able to provide their patients with the best available treatment and care.”

The BCCSU is home to the BC Node of the Canadian Research Initiative in Substance Misuse (CRISM), a national network of researchers, service providers, policy makers, and people with lived experience, which developed the new national guideline. CRISM received funding from the Canadian Institutes of Health Research to develop the guideline, which was published in CMAJ (Canadian Medical Association Journal).

Similar to the B.C. guideline, the national guideline recommendations include:

  • Avoid the common practice of providing withdrawal management alone without transition to long-term treatment since this can increase risk of relapse and death.
  • Start opioid agonist treatment with buprenorphine-naloxone whenever possible to reduce risk of toxicity, illness, and death.
  • Consider transitioning to methadone treatment for people who respond poorly to buprenorphine-naloxone.
  • Start opioid agonist treatment with methadone when buprenorphine-naloxone is not the preferred option.
  • Consider transitioning to buprenorphine-naloxone for people who respond well to methadone and who want simpler treatment.
  • Consider slow-release oral morphine, prescribed as daily witnessed doses, for patients who do not respond to the above therapies.