The Canadian Medical Association Journal has published the updated guidelines for treatment of opioid use disorder that "strongly recommends" evidence-based treatments and harm reduction strategies.
The latest report updates guidelines previously published in 2018.
The harm reduction approach recognizes that not all people with addictions can abstain or just stop using a substance. It is an evidence-based, client-centred approach that seeks to reduce the health and social harms associated with addiction and substance use.
In a new report published this week CMAJ said it favours "evidence-based treatments and harm reduction strategies for adults with opioid use disorder, regardless of severity."
The journal said the use of Buprenorphine and methadone are recommended as the first-line treatment options, and slow-release oral morphine (SROM) is recommended as a second-line option.
The CMAJ report said these 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.
The study also suggested not enough is known about the effectiveness of slow-release morphine options and said more study is needed to address gaps in knowledge.
"Recent, high-certainty evidence regarding the effectiveness of slow-release oral morphine is lacking, as no RCT (Randomized controlled trials) comparing slow-release oral morphine to another opioid agonist therapy has been published in the last decade,” said the study.
“The generation of new evidence is hampered by the limited access to this therapy in most settings. In Canada it is currently used off label, and we recommend its use as a second-line option, but further studies are needed to confirm its comparative safety and efficacy," the study continued.
The CMAJ authors also wrote against the idea that treatment is for withdrawal alone.
"As per the 2018 guideline, management that comprises withdrawal alone is not recommended. Additionally, psychosocial treatments can be offered but should not be mandatory and, therefore, should not prevent access to evidence-based pharmacologic therapies," said the study.
"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," said the study.
A full text version of the CMAJ report is available online here.
