Management of Opioid Use Disorder (2024 CRISM Guideline)

Publication Date: November 12, 2024
Last Updated: November 13, 2024

Summary of Recommendations

Buprenorphine and methadone should both be considered as standard first-line treatment options for opioid agonist therapy.
  • For people who initiate opioid agonist therapy with buprenorphine, clinicians should be aware of the higher risk of attrition after the first month of initiation and offer alternative opioid agonist medications in these circumstances (high certainty).
  • When considering methadone, clinicians should be aware of the higher risk of mortality during the first month compared with the remainder of the treatment period (moderate certainty).
(S, H )
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Opioid agonist therapy with slow-release oral morphine should be available and offered as a second-line treatment option. (S, M )
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Patients with opioid use disorder should not be offered withdrawal management alone because of the increased rates of relapse, morbidity, and mortality. Concurrent long-term addiction treatment is recommended. (S, M )
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When withdrawal management alone is pursued, a supervised slow opioid agonist taper (depending on the patient) should be provided, with close follow-up, and opioid agonist therapy should immediately be offered if the risk of relapse emerges. (S, M )
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For patients with a successful and sustained response to opioid agonist therapy who wish to discontinue opioid agonist therapy (i.e., desiring medication cessation), clinicians should consider a slow taper approach (depending on the patient). Ongoing addiction care should be considered upon cessation of opioid use. (S, M )
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Psychosocial treatments, interventions, and supports can be offered as adjunct treatments to opioid agonist therapy to increase treatment retention. (S, M )
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Psychosocial treatment should not be a mandatory component of standard treatment for opioid use disorder and should not prevent access to opioid agonist therapy. (S, M )
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Harm reduction strategies should be offered as part of the continuum of care for patients with opioid use disorder. (S, M )
Current evidence supports the use of the following harm reduction programs: provision of sterile consumption equipment, overdose prevention education, and access to take-home naloxone kits.
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For patients who decline or are not on standard treatments for opioid use disorder and have withdrawn from opioids, oral naltrexone could be discussed as an adjunct pharmacological option. (, )
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Pregnant people with opioid use disorder who are not in treatment should be encouraged to start a first-line treatment as soon as possible during pregnancy. (, )
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Recommendation Grading

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.

Overview

Title

Management of Opioid Use Disorder (2024 CRISM Guideline)

Authoring Organization

Canadian Research Initiative in Substance Matters

Publication Month/Year

November 12, 2024

Last Updated Month/Year

November 13, 2024

Document Type

Guideline

Country of Publication

CA

Document Objectives

In an evolving landscape of practices and policies, reviewing and incorporating the latest scientific evidence is necessary to ensure optimal clinical management for people with opioid use disorder. We provide a synopsis of the 2024 update of the 2018 National Guideline for the Clinical Management of Opioid Use Disorder, from the Canadian Research Initiative in Substance Matters.

Inclusion Criteria

Male, Female, Adolescent, Adult, Older adult

Health Care Settings

Ambulatory

Intended Users

Addiction treatment specialist, counselor, nurse, nurse practitioner, physician, physician assistant, psychologist

Scope

Counseling, Diagnosis, Assessment and screening, Treatment, Management, Prevention, Rehabilitation

Diseases/Conditions (MeSH)

D000080052 - Opioid Epidemic, D000073316 - Addiction Medicine

Keywords

OUD, Opioid Use Disorder

Source Citation

Management of opioid use disorder: 2024 update to the national clinical practice guideline
Igor Yakovenko, Yvette Mukaneza, Katuschia Germé, Jacob Belliveau, Ross Fraleigh, Paxton Bach, Ginette Poulin, Peter Selby, Marie-Ève Goyer, Thomas D. Brothers, Jürgen Rehm, David C. Hodgins, Sherry H. Stewart, Evan Wood, Julie Bruneau CMAJ Nov 2024, 196 (38) E1280-E1290; DOI: 10.1503/cmaj.241173