Opioid use disorder is one of the most challenging forms of addiction facing the health care system in British Columbia and a major driver of illicit drug overdose deaths in the province.
In the context of the current public health emergency, the BC Centre on Substance Use has developed provincial evidence-based guidelines articulating the full range of therapeutic options for the optimal treatment of adults and youth with varying presentations of opioid use disorder.
These guidelines are intended for use for all BC physicians, nursing and allied health professionals, and other care providers involved in the treatment of individuals with opioid use disorder. While this guideline supports the diversity of possible treatments available for individuals with opioid use disorder, it strongly recommends against a strategy involving withdrawal management alone, since this approach has been associated with elevated risk of HIV and hepatitis C transmission, elevated rates of overdose deaths in comparison to providing no treatment, and nearly universal relapse when implemented without plans for transition to long-term evidence-based addiction treatment (e.g., opioid agonist treatment). However, this guideline also acknowledges the importance of strengthening the residential treatment system with a view to aiding individuals seeking long-term cessation of opioid use who do not wish to pursue pharmacological treatment, but may still wish to use other various pharmacotherapies for symptom management during withdrawal.
Opioid Use Disorder Guidelines:
- Guideline for the Clinical Management of Opioid Use Disorder
- Guidance for Injectable Opioid Agonist Treatment for Opioid Use Disorder
- Treatment of Opioid Use Disorder During Pregnancy
- Treatment of Opioid Use Disorder for Youth
As of January 26, 2022: After over a year of Risk Mitigation prescribing experience, the emergence of preliminary evaluation data and experience from clinicians and people who use drugs has led to the development of an update to Interim Clinical Guidance: Risk Mitigation in the Context of Dual Health Emergencies, which features expanded and amended guidance for mitigating substance-related risks in the context of COVID-19.
The clinical experience from Risk Mitigation prescribing also informed the development of an Opioid Use Disorder Practice Update. This document helps to enact, but is distinct from, Access to Prescribed Safer Supply in British Columbia: Policy Direction which was released in July 2021 by the MMHA, MoH, and the Office of the Provincial Health Officer.
- Guidance: Risk Mitigation in the Context of Dual Public Health Emergencies (January 2022)
- Guidance: Opioid Use Disorder: Practice Update (January 2022)
- Summary – Understanding Risk Mitigation & Opioid Use Disorder Practice Update
- FAQ – Risk Mitigation in the Context of Dual Public Health Emergencies Update and Opioid Use Disorder Practice Update
- Webinar – Risk Mitigation and OUD Practice Update (Provincial)
- Webinar – Risk Mitigation and OUD Practice Update (Rural)
- Sublocade (Extended-Release Buprenorphine) Information - January 11, 2022
- Methadone Formulations Options Bulletin - October 18, 2021
- Compounded Methadone Bulletin - October 18, 2021
- Benzodiazepines and Opioids - June 8, 2021
- Opioid Agonist Treatment Alert - SROM - March 26, 2021
- COVID-19: Information for Opioid Agonist Treatment Prescribers and Pharmacists - March 31, 2020
- Metadol Update - May 28, 2019
- Withdrawal Management
- Consent Form for Withdrawal Management
- 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
- Buprenorphine-Naloxone Treatment Agreement and Consent Form
- Clinical Opiate Withdrawal Scale
- DSM-5 Criteria for opioid Use Disorder
- Methadone Treatment Agreement and Consent Form
- 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
As of June 5, 2017, the BCCSU is responsible for the educational and clinical care guidance activities for all health care professionals who are prescribing medications to treat opioid addiction (i.e., methadone, buprenorphine/naloxone, slow-release oral morphine, injectable opioid agonist treatment). If you are seeking education and training for these treatment options, please visit our Provincial Opioid Addiction Treatment Support Program (POATSP) page. Additional training and educational resources for managing opioid use disorder are available as noted below.
Education & Training Resources: