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provide updates on the provision of OAT in line with planned updates to the provincial OUD Guideline, is now considered out of date.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.
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.
A Guideline for the Clinical Management of Opioid Use Disorder
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.
The following are additional Opioid Use Disorder Guideline learning materials for clinicians.
- 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
- 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): Extended-release buprenorphine
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.
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: