Management of opioid use disorder: 2024 update to the national clinical practice guideline.

CMAJ

Department of Psychology and Neuroscience (Yakovenko, Belliveau, Fraleigh, Stewart); Department of Psychiatry (Yakovenko, Stewart), Dalhousie University, Halifax, NS; Research Centre of Centre Hospitalier de l'Université de Montréal (Mukaneza, Germé), Montréal, Que.; Department of Medicine (Bach, Wood), University of British Columbia; British Columbia Centre on Substance Use (Bach, Wood), Vancouver, BC; Waypoint Centre for Mental Health Care (Poulin); Department of Psychiatry (Poulin), University of Manitoba, Winnipeg, Man.; Addictions Divisions (Selby), Centre for Addition and Mental Health; Dalla Lana School of Public Health (Selby, Rehm), University of Toronto, Toronto, Ont.; Department of Family Medicine and Emergency Medicine (Goyer, Bruneau), Université de Montréal; Centre de recherche et d'aide pour narcomanes (Goyer), Centre intégré universitaire de santé et de services sociaux du Centre-Sud-del'Île-de Montréal, Montréal, Que.; Division of General Internal Medicine (Brothers), Department of Medicine, Dalhousie University, Halifax, NS; Addiction Medicine Consult Service, Mental Health & Addictions Program (Brothers), Nova Scotia Health; Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (Rehm), Toronto, Ont.; Department of Psychology (Hodgins), University of Calgary; Department of Psychology (Hodgins), Alberta Gambling Research Institute, Calgary, Alta.; Drug addiction service (Bruneau), Centre Hospitalier de l'Université de Montréal, Montréal, Que.

Published: November 2024

AI Article Synopsis

  • - The 2024 update of the 2018 National Guideline for Clinical Management of Opioid Use Disorder emphasizes the need for current scientific evidence to inform treatment practices for opioid use disorder in Canada.
  • - A comprehensive review from 2017 to 2023 was conducted to revise the guidelines, involving a national committee including those with personal experience in opioid use disorder, and ensuring quality through established methods.
  • - Key changes in the recommendations include recognizing methadone and buprenorphine as equally effective first-line treatments, introducing slow-release oral morphine as a second-line option, and highlighting that psychosocial interventions should be optional rather than mandatory.

Article Abstract

Background: 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.

Methods: For this update, we followed the United States Institute of Medicine's Standards for Developing Trustworthy Clinical Practice Guidelines and used the Appraisal of Guidelines Research and Evaluation-Recommendation Excellence tool to ensure guideline quality. We carried out a comprehensive systematic literature review, capturing the relevant literature from Jan. 1, 2017, to Sept. 14, 2023. We drafted and graded recommendations according to the Grading of Recommendations, Assessments, Development and Evaluation approach. A multidisciplinary external national committee, which included people with living or lived experience of opioid use disorder, provided input that was incorporated into the guideline.

Recommendations: From the initial 11 recommendations in the 2018 guideline, 3 remained unchanged, and 8 were updated. Specifically, 4 recommendations were consolidated into a single revised recommendation; 1 recommendation was split into 2; another recommendation was moved to become a special consideration; and 2 recommendations were revised. Key changes have arisen from substantial evidence supporting that methadone and buprenorphine are similarly effective, particularly in reducing opioid use and adverse events, and both are now considered preferred first-line treatment options. Slow-release oral morphine is recommended as a second-line option. Psychosocial interventions can be offered as adjunctive treatment but should not be mandatory. The guideline reaffirms the importance of avoiding withdrawal management as a standalone intervention and of incorporating evidence-based harm reduction services along the continuum of care.

Interpretation: This guideline update presents new recommendations based on the latest literature for standardized management of opioid use disorder. The aim is to establish a robust foundation upon which provincial and territorial bodies can develop guidance for optimal care.

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11573384PMC
http://dx.doi.org/10.1503/cmaj.241173DOI Listing

Publication Analysis

Top Keywords

opioid disorder
20
management opioid
12
2024 update
8
clinical practice
8
clinical management
8
guideline
6
recommendations
6
management
5
disorder
5
opioid
5

Similar Publications

Want AI Summaries of new PubMed Abstracts delivered to your In-box?

Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!