An updated evidence-based guideline published in the Canadian Medical Association Journal (CMAJ) aims to enhance the management of opioid use disorder (OUD) by recommending buprenorphine and methadone as first-line treatment options. This revision comes in response to the alarming rise in opioid-related deaths across Canada, which have surged by 184% from 2016 to 2023, increasing from 2,831 deaths to 8,049.
Dr. Ginette Poulin, a family physician at the University of Manitoba, emphasized the urgent need for effective treatment strategies. “Opioid use disorder and opioid-related harms have devastating outcomes for our communities across Canada. With the growing dangers associated with the illicit market, we need to ensure that we are sharing the most relevant therapeutic tools and up-to-date knowledge to help providers and communities address this complex issue,” she stated.
The updated guideline builds upon the 2018 national framework for the clinical management of OUD developed by the Canadian Research Initiative in Substance Matters. It focuses primarily on oral treatments and includes specific considerations for pregnant individuals. Notably, the guideline does not cover injectable opioid agonist therapy, extended-release agonists, or antagonists.
Dr. Igor Yakovenko, the lead author and associate professor at Dalhousie University, highlighted the importance of staying abreast of new research in the field. “The management of opioid use disorder is a rapidly changing landscape. This guideline provides an important update to health practitioners on the latest science, enabling Canadian providers to maintain a high standard of evidence-based care,” he said.
Key updates from the guideline include the recognition of methadone as a standard first-line treatment alongside buprenorphine–naloxone, which was previously the sole recommended option. This change reflects new research and aims to broaden the therapeutic choices available to healthcare providers.
The guideline is intended for a wide range of healthcare professionals, including physicians, nurse practitioners, pharmacists, clinical psychologists, social workers, and medical educators, all of whom play a role in treating individuals with opioid use disorder.
Dr. Peter Selby from the Centre for Addiction and Mental Health and the University of Toronto stressed the need for action. “Too many people die from untreated opioid addiction in Canada. We have medicines that help people stop using, but too few are treated due to stigma and a lack of prescribers who know how to help. These national guidelines will assist healthcare providers in utilizing proven medications to prevent death and support recovery,” he remarked.
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