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

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.

Background

People with opioid use disorder who do not use opioids for an extended period of time may experience serious and painful physical withdrawal symptoms that should be treated as soon as possible. Buprenorphine/naloxone has been shown to be more effective than clonidine or lofexidine in improving symptoms of withdrawal and is associated with fewer side effects. However, buprenorphine/naloxone may precipitate withdrawal in people who have recently used opioids; therefore, withdrawal symptoms should be of moderate to severe intensity before buprenorphine/naloxone is given.

Once acute withdrawal has been treated, care providers should focus on addressing the person’s long-term treatment and harm reduction goals and refer them to appropriate resources as necessary. If a person opts for opioid agonist therapy, bridging treatment with buprenorphine/naloxone should be offered until their follow-up appointment, which should occur within 3 days.

Source: Advisory committee consensus

What This Quality Statement Means

For People With Opioid Use Disorder

If you are feeling sick because you have not had opioids for a while, you might be experiencing withdrawal. You can go to your care provider to get help to feel better. If your care provider says that you are experiencing moderate or severe withdrawal, they will make sure you get medication within 2 hours to help you feel better. Once you are feeling better, your care provider will talk with you about different ways to manage your opioid use disorder and ways to reduce your risk of harm.

For Care Providers

If a person presents with moderate or severe symptoms of opioid withdrawal, offer treatment within 2 hours of presentation. If buprenorphine/naloxone is not available through an on-site process, a patient-specific prescription can be written and filled in the community for witnessed ingestion on site or at the pharmacy. Buprenorphine/naloxone is the suggested first-line treatment for withdrawal symptoms. Once the acute withdrawal has been treated, discuss the person’s goals for long-term treatment and harm reduction, and refer them to appropriate resources as necessary. If they opt for opioid agonist therapy, offer them bridging treatment with buprenorphine/naloxone to use until their follow-up appointment, which should occur within 3 days.

For Health Services

Ensure systems, processes, and resources are in place to allow care providers to provide people with opioid use disorder immediate access to treatment for opioid withdrawal. This includes having policies in place to enable care providers to give buprenorphine/naloxone quickly to relieve opioid withdrawal symptoms and to refer patients to the appropriate resources following symptom control.

Quality Indicators

Process Indicator

Percentage of people with opioid use disorder in moderate or severe withdrawal who receive buprenorphine/naloxone within 2 hours of presentation

Denominator: total number of people with opioid use disorder in moderate or severe withdrawal
Numerator: number of people in the denominator who receive buprenorphine/
naloxone within 2 hours of presentation
Data source: local data collection

Definitions Used Within This Quality Statement

Moderate or severe withdrawal

Withdrawal symptoms occur when a person has either been administered an opioid antagonist (i.e., naloxone) or there is a reduction or cessation of opioid use following regular use. Common withdrawal symptoms include the following:

The Clinical Opiate Withdrawal Scale can be used to assess the severity of withdrawal symptoms. Points are attributed to symptom severity, with a total score of 5 to 12 indicating mild withdrawal, 13 to 24 indicating moderate withdrawal, 25 to 36 indicating moderately severe withdrawal, and more than 36 indicating severe withdrawal.

Evidence to Improve Care