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

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.

Background

Following the identification of suspected opioid use disorder, it is important to rapidly initiate a formal diagnosis. A diagnosis is required to start opioid agonist therapy and can be made by a physician, psychologist, or nurse practitioner, although only physicians and nurse practitioners can prescribe opioid agonist therapy. For people with opioid use disorder who are pregnant, it is particularly important that they are started on opioid agonist therapy as soon as possible.

Prescribers must complete a full assessment to determine if opioid agonist therapy is appropriate for a particular person. If it is decided that opioid agonist therapy is appropriate, and if the person with opioid use disorder chooses to receive opioid agonist therapy, prescribers should recommend either buprenorphine/naloxone or methadone. Individual characteristics, preferences, and ease of accessibility to treatment should be considered when choosing between opioid agonist therapies. Buprenorphine/naloxone should be the treatment of choice in most cases, as it is a safer medication and more easily accessible than methadone in rural and remote locations. For example, pregnant people with opioid use disorder living in remote communities are often unable to access methadone in their home community and must move to a community that does offer it to receive treatment.

Initiating and maintaining opioid agonist therapy with buprenorphine/naloxone or methadone can be done in primary care, integrated care (primary care and addiction care), or specialized clinic settings.

All addiction treatment services and addiction care providers should facilitate the continued use of opioid agonist therapy for those currently receiving this treatment and facilitate access to it for those requesting initiation. If a person receiving opioid agonist therapy enters an inpatient facility (e.g., a hospital or residential addiction treatment program) or a correctional facility, their opioid agonist therapy should be continued without disruption. The last dose of opioid agonist therapy should be verified, and appropriate adjustments should be made to the dose if there have been missed doses.

What This Quality Statement Means

For People With Opioid Use Disorder

Opioid agonist therapy reduces cravings for opioids and blocks the effects of other opioids. Because of this, it makes your care plan safer and more effective. There are two medications used for opioid agonist therapy. One is a combination of buprenorphine and naloxone, which is also called Suboxone. The other is methadone. Your care provider should talk with you about the differences between these two medications to help you make the best choice for you.

You should be given opioid agonist therapy within 3 days of being diagnosed with or identified as having opioid use disorder, no matter where you first ask for treatment or where you receive treatment.

If you are already taking opioid agonist therapy and you go into a hospital, a residential addiction treatment program, or a correctional facility, your treatment should be continued without stopping at any time.

For Care Providers

If the person you are treating agrees to opioid agonist therapy, start them on buprenorphine/ naloxone or methadone as soon as possible. Buprenorphine/naloxone should be the treatment of choice in most cases, especially if methadone is not locally available and requires extensive travel for the person to obtain. If you are unable to prescribe opioid agonist therapy, refer the person to a care provider or organization that can initiate treatment within no more than 3 days.

For Health Services

Ensure systems, processes, and policies are in place to allow people to receive opioid agonist therapy within 3 days of identification or diagnosis regardless of where they present for treatment (whether hospital, residential addiction treatment facility, or correctional facility). No one with opioid use disorder receiving opioid agonist therapy should be refused access to any type of treatment (including inpatient addiction services). If an organization is unable to provide opioid agonist therapy (e.g., if no physicians or nurse practitioners are available), the organization should partner with an organization or clinician able to provide on-site access to opioid agonist therapy.

Quality Indicators

Process Indicator

Percentage of people diagnosed with or identified as having opioid use disorder who receive opioid agonist therapy within 3 days

Denominator: total number of people diagnosed with or identified as having opioid use disorder
Numerator: number of people in the denominator who are offered opioid agonist therapy within 3 days of diagnosis or identification
Data source: local data collection

Structural Indicator

Local availability of access to opioid agonist therapy

Data sources: ConnexOntario, Ministry of Health and Long-Term Care

Evidence to Improve Care