CRISM Clinical Resources & Guidance
As part of its mandate to translate the best scientific evidence into clinical practice and policy change, CRISM has developed a suite of national clinical resources to support the implementation of evidence-based practices in Canada.
The first-ever Canadian guideline for treating high-risk drinking and alcohol use disorder was published October 2023.
Developed in partnership between the Canadian Research Initiative on Substance Misuse (CRISM) and BC Centre on Substance Use (BCCSU), the guideline provides 15 evidence-based recommendations to reduce harms associated with high-risk drinking and to support people’s treatment and recovery from alcohol use disorder.
The guideline provides recommendations for the clinical management of high-risk drinking and alcohol use disorder to support primary healthcare providers to implement evidence-based screening and treatment interventions.
Developed by a 36-member committee, the guideline is based on the latest evidence, expert consensus, lived/living experience as well as clinical experience from across Canada. It makes recommendations for care providers about how to ask about alcohol, diagnose alcohol use disorder, manage alcohol withdrawal, and create treatment plans based on the individual’s goals.
- Canadian Clinical Guideline High Risk Drinking and Alcohol Use Disorder
- Recommendations at a glance
- Guideline synopsis (2023) — Canadian Medical Association Journal (CMAJ)
- www.helpwithdrinking.ca — New website with resources for the public and clinicians
The Lower Risk Cannabis Use Guidelines (LRCUG) are an evidence-based public health intervention tool, allowing cannabis users to modify and reduce their risks for health harms by following scientifically grounded recommendations. The present work was led by Dr. Benedikt Fischer of the Ontario CRISM Node and a team of renowned addiction and health science experts. The 2017 guideline is the result of a comprehensive scientific update and revisions to the original guideline (from 2011) and was published in the American Journal of Public Health.
Resources:
CRISM developed the first national injectable opioid agonist treatment (iOAT) guideline in the world. This guideline includes two companion documents: a clinical guideline and an operational guidance document.
Resources:
- National Injectable Opioid Agonist Treatment Guideline
- National Injectable Opioid Agonist Treatment for Opioid Use Disorder Operational Guidance
- Guideline Synopsis (2019) — Canadian Medical Association Journal (CMAJ)
- Podcast: Injectable opioid agonist treatment for opioid use disorder: a national clinical guideline
- Supervised Consumption Sites vs iOAT
- Sample Program Expectations
- Sample Patient Bill of Rights
- Sample Client Safety Care Plan
- Sample Treatment Plan
- Sample Floor Plan
- Lessons Learned
- FAQ for Patients and Families
- Case Studies
- Sample Diacetylmorphine Titration Pre-Printed Order
- Sample Hydromorphone Titration Pre-Printed Order
- Sample Hydromorphone Titration Hospital Pre-Printed Order Package
- Sample Hydromorphone Maintenance Pre-Printed Order
- Journal Article: Perspectives of people with opioid use disorder on improving addiction treatments and services (Lachapelle, et al, 2020)
Managed alcohol programs (MAPs) are a harm reduction intervention within the continuum of AUD care for individuals with severe alcohol use disorder (AUD) for whom other treatments are not an effective option – particularly those who face additional barriers to basic care and psychosocial supports due to poverty and homelessness.
MAPs provide alcohol and supports for those with severe AUD to reduce their consumption, prevent deadly symptoms of withdrawal, and provide an alternative to non-beverage alcohol consumption.
The BC Centre on Substance Use, in partnership with the Canadian Institute for Substance Use Research, convened an expert national panel to develop MAPs operational information. The guideline, published July 18, 2023, aims to support the availability of these programs nationally. Canadian AUD clinical guidelines are currently in development with an anticipated publication date of October 2023.
This work was supported by funding from Health Canada.
Resources:
- Canadian Operational Guidance — Managed Alcohol Programs
- MAPS — Financial Management: Sample financial management consent form
- MAPS — Sample Client Alcohol Management Plan and Agreement
- MAPS — Example Client Bill of Rights
- MAPS — Alcohol Inventory Control
- MAPS — Sample Pre-dose Intoxication Assessment Forms
- MAPS — Sample Clinical Assessment Form
- MAPS — Alcohol Use Disorder Screening and Assessment Tools
- MAPS — Sample Managed Alcohol Order
As Canada finds itself amidst an evolving opioid public health crisis, including escalating mortality from overdose, the provision of ‘naloxone’ has been recognized as a key emergency measure and targeted tool to reverse opioid overdose and prevent mortality. Naloxone availability and distribution has evolved in different jurisdictions across Canada, in rather diversified ways; for example, federal and provincial legislation/regulations have been modified to expand naloxone distribution, and different naloxone distribution models and practices (e.g., injection/nasal; multiple availability sources; provision through first responders, peers, take-home programs) have been proposed or implemented in different jurisdictions, including provinces and/or municipalities. Through a CIHR-funded program, CRISM examined these issues through an Environmental Scan (completed 2019) and a Scoping Review (completed 2020) and produced a Best Practice Guideline.
Resources:
Developed in partnership between the Canadian Research Initiative on Substance Misuse (CRISM) and BC Centre on Substance Use (BCCSU), the guideline provides 15 evidence-based recommendations to reduce harms associated with high-risk drinking and to support people’s treatment and recovery from alcohol use disorder.
The guideline provides recommendations for the clinical management of high-risk drinking and alcohol use disorder to support primary healthcare providers to implement evidence-based screening and treatment interventions.
Developed by a 36-member committee, the guideline is based on the latest evidence, expert consensus, lived/living experience as well as clinical experience from across Canada. It makes recommendations for care providers about how to ask about alcohol, diagnose alcohol use disorder, manage alcohol withdrawal, and create treatment plans based on the individual’s goals.
The first-ever Canadian guideline for treating high-risk drinking and alcohol use disorder was published October 2023. The latest 2024 version has been updated to include additional measures to help reduce the epidemic. Key advancements include the removal of methadone prescription restrictions in 2018 and the improvement of treatment accessibility. However, the COVID-19 pandemic exacerbated opioid-related harms due to limited service access and a toxic drug supply, with fatalities surpassing pre-pandemic levels.To ensure optimal management of opioid use disorder (OUD), the updated 2024 CRISM National Guideline incorporates recent research, clinical insights, and input from individuals with lived experience, aiming to provide evidence-based high-standard care practices.
Note that Health Canada has removed the requirement for practitioners to obtain a section 56 exemption to prescribe methadone, effective May 19, 2018. See the Section 56 Consultation page for more information.
This initiative was funded by a contribution from Health Canada’s Substance Use and Addictions Program (SUAP). The views expressed herein do not necessarily represent the views of Health Canada.
Resources:
- National Guideline of Clinical Management of Opioid Use Disorder (Updated 2024)
- Guideline synopsis (2024)— Canadian Medical Association Journal
- Recommendations at a glance
- Podcast: Management of opioid use disorders: a national clinical practice guideline
- Did you know? Buprenorphine/Naloxone
- Did you know? Slow-release oral morphine
- Withdrawal Management Safety Bulletin
Supervised consumption services (SCS) are health facilities where people consume drugs and are monitored by staff who provide education on harm reduction and provide emergency medical care for overdose. SCS also distribute sterile drug use equipment and can act as a pathway to other health services. SCS are authorized by federal or provincial authorities, which protects staff and participants from being charged with possession of illegal drugs while on site.
More information can be found at whyscs.ca
The guideline was developed as part of a CIHR-funded implementation science program and is designed to address some of the current impediments to the scale-up and sustainability of SCS in Canada by synthesizing and disseminating existing knowledge, and generating new research evidence. The guideline is intended to assist communities in their efforts to plan, design, secure support for, and implement SCS.
Resources:
The following training manual focuses on how to effectively implement Contingency Management (CM) in various clinical environments. The manual is largely informed by two studies in Alberta, Canada—CRISM Project Engage and The PRISE Project (PRoviding Incentives to Sustain Engagement).
Project Engage involved uncontrolled prospective trials at four study sites delivering substance use treatment, two inpatient settings and two outpatient settings. The trials examined whether CM
was helpful in promoting treatment related goals (e.g., creative arts), abstinence, and treatment attendance among individuals with substance use concerns.
The PRISE Project, a clinical trial, examined whether CM was helpful in encouraging treatment attendance among individuals seeking treatment for their substance use concerns at two outpatient addiction and mental health clinics.
Project Engage and The PRISE Project were pragmatically informative when it comes understanding the nuances and challenges of implementing CM in various clinical settings where the structure of treatment programs varies widely (e.g., different treatment schedules, inpatient and outpatient, in-person or virtual).
The manual also contains links to training videos.
Resources:
For more information and to view other CRISM-developed resources, please visit the CRISM website below.