Opioid Use Disorder (Opioid Addiction)

Care for People 16 Years of Age and Older

Click below to see a list of brief quality statements and scroll down for more information.

Quality Statements in Brief

Quality standards are sets of concise statements designed to help health care professionals easily and quickly know what care to provide, based on the best evidence.

See below for the quality statements and click for more detail.

Quality Statement 1: Identifying and Diagnosing Opioid Use Disorder
People at risk of opioid use disorder are asked about their opioid use and are further assessed as appropriate.

Quality Statement 2: Comprehensive Assessment and Collaborative Care Plan
People diagnosed with or identified as having opioid use disorder have a comprehensive assessment and a care plan developed in collaboration with their care providers.

Quality Statement 3: Addressing Physical Health, Mental Health, Additional Addiction Treatment Needs, and Social Needs
People with opioid use disorder have integrated, concurrent, culturally safe management of their physical health, mental health, additional addiction treatment needs, and social needs.

Quality Statement 4: Information to Participate in Care
People with opioid use disorder are provided with information to enable them to participate in their care. If their family is involved, they are also provided with this information.

Quality Statement 5: Opioid Agonist Therapy as First-Line Treatment
People with opioid use disorder are informed that treatment that includes opioid agonist therapy is safer and more effective than treatments that do not include opioid agonist therapy.

Quality Statement 6: Access to Opioid Agonist Therapy
People diagnosed with or identified as having opioid use disorder have access to opioid agonist therapy as soon as possible, within a maximum of 3 days.

Quality Statement 7: Treatment of Opioid Withdrawal Symptoms
People with opioid use disorder who are in moderate or severe withdrawal from opioids are offered relief of their symptoms with buprenorphine/naloxone within 2 hours.

Quality Statement 8: Access to Take-Home Naloxone and to Overdose Education
People with opioid use disorder and their families have immediate access to take-home naloxone and to overdose education.

Quality Statement 9: Tapering Off of Opioid Agonist Therapy
People who have achieved sustained stability on opioid agonist therapy who wish to taper off are supported in a collaborative slow taper if clinically appropriate.

Quality Statement 10: Concurrent Mental Health Disorders
People with opioid use disorder who also have a mental health disorder are offered concurrent treatment for their mental health disorder.

Quality Statement 11: Harm Reduction
People who use opioids have same-day access to harm reduction services. A comprehensive harm reduction approach includes education, safe supplies, infectious disease testing, vaccinations, appropriate referrals, and supervised consumption services.

Resources Quality Statements Advisory Committee About

5

Opioid Agonist Therapy as First-Line Treatment

People with opioid use disorder are informed that treatment that includes opioid agonist therapy is safer and more effective than treatments that do not include opioid agonist therapy.

Background

People with opioid use disorder who are treated with opioid agonist therapy have better retention in addiction treatment, less use of addictive substances, improved health and social functioning, and lower rates of mortality than those who do not receive opioid agonist therapy as part of their treatment. Most people who stop taking opioids without first being stabilized on opioid agonist therapy will relapse. Relapse is particularly dangerous because a person who has stopped taking opioids has a reduced tolerance and is therefore at an increased risk of overdose and death. Use of opioid agonist therapy is particularly important for pregnant people, for whom the benefits of therapy far outweigh the potential risks of neonatal abstinence syndrome, which is a time-limited and treatable condition.

People with opioid use disorder who decline opioid agonist therapy should be offered a supervised, slow opioid agonist taper using either buprenorphine/naloxone or methadone, lasting longer than 1 month. They should also be offered concurrent psychosocial treatment, support, and monitoring for at least 6 months.

All people who are considering immediate opioid cessation or who have stopped taking opioids should be counselled on the risks of overdose owing to a reduction in their opioid tolerance. They should also be provided with take-home naloxone and taught how to administer it and how to recognize and respond to emergencies.

What This Quality Statement Means

For People With Opioid Use Disorder

When you and your care provider work on your care plan, your care provider will explain the different types of treatment available to you. No matter where you seek treatment, you should be offered a treatment called opioid agonist therapy. This is sometimes called maintenance therapy. This treatment makes your care plan safer and more effective.

If you and your care provider have discussed your treatment options for opioid use disorder, and you understand that a treatment that includes opioid agonist therapy is safer and more effective than treatments that do not include opioid agonist therapy, and you decide that opioid agonist therapy is not right for you, your care provider should offer you a supervised, slow opioid agonist taper. Your care provider will put you on methadone or buprenorphine/naloxone and slowly lower the dose of your medication over a minimum of 1 month. This is done to prevent you from feeling sick, which happens when you stop taking opioids abruptly. Your care provider should also offer you regular counselling and support while you lower your dose and for 6 months after that.

For Care Providers

Inform people with opioid use disorder that incorporating opioid agonist therapy into their care plan is recommended. However, treatment is ultimately the person’s decision; if they opt to forgo stabilization and opioid agonist therapy, their decision must be respected. If they decline opioid agonist therapy, inform them of the harms associated with immediate opioid cessation, and encourage a slow taper with buprenorphine/naloxone or methadone. Provide them with take-home naloxone, instructions on overdose prevention, and contact information for harm reduction services. If family is involved in the person’s care, and if the person consents, the family should also be provided with take-home naloxone, instructions on overdose prevention, and contact information for harm reduction services.

For Health Services

Ensure systems, processes, and resources are in place to ensure that accurate, evidence-based information on treatment options is provided to all people with opioid use disorder and their families as appropriate. This includes the information that treatment that includes opioid agonist therapy is safer and more effective than treatments that do not include opioid agonist therapy.

Quality Indicators

Process Indicator

Percentage of people with opioid use disorder who are informed that treatment that includes opioid agonist therapy is safer and more effective than treatments that do not include opioid agonist therapy

Denominator: total number of people with opioid use disorder
Numerator: number of people in the denominator who report being told that treatment that includes opioid agonist therapy is safer and more effective than treatments that do not include opioid agonist therapy
Data source: local data collection

Evidence to Improve Care