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

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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.

Background

Stability in treatment is attained once a person with opioid use disorder is functioning well on an optimal dose of opioid agonist therapy. An optimal dose is one that allows a person to be free of opioid withdrawal symptoms and cravings for the full 24-hour dosing interval without experiencing intoxication or sedation from the medication.

Once stability is achieved, the frequency of a person’s routine visits with a care provider for opioid agonist therapy should be reassessed. Care providers should consider the balance between safety and the potential burden that the visits have on the person’s quality of life.

Following a period of sustained stability, some people may want to taper off of opioid agonist therapy. The ideal duration of stability before tapering off depends on the duration and severity of a person’s opioid use disorder and instability. For example, those with a long history of opioid use may require a longer period of regular opioid agonist therapy before tapering than those with a shorter history of opioid use. Tapering may not be appropriate for some people, and such individuals should be encouraged to continue their opioid agonist therapy indefinitely. However, if a person insists on tapering against medical advice, care providers should respect this request and initiate a taper.

Prior to initiating a collaborative slow taper, all people, even those who have been stable for many years, should be counselled on the risks of overdose owing to reduced tolerance, provided with naloxone, and taught how to administer naloxone and how to recognize and respond to emergencies.

For people who would like to stop methadone, but who are not ready to discontinue opioid agonist therapy, providers should offer a switch to buprenorphine/naloxone. Buprenorphine/naloxone is safer, can be prescribed in primary care settings, is available in more rural and remote locations, and may be easier to taper to discontinuation. If this switch is beyond the scope of practice or expertise, the prescriber should consult with a care provider who has the appropriate expertise.

What This Quality Statement Means

For People With Opioid Use Disorder

If you are on opioid agonist therapy and you are feeling better, you or your care provider may suggest slowly lowering the dose of your medication over time. This is called tapering, and the goal is to eventually stop your opioid agonist therapy. Tapering may be considered when:

You feel comfortable with the dose you are on
Your health and social functioning have gotten better and stayed better for 1 year or more
You want to stop taking opioid agonist therapy
You have adequate supports available, like friends, family, or a peer support group

Tapering is not a good option for everyone. The tapering process is different for each person, depending on how long opioids have been negatively impacting your life and how severe your opioid use disorder is.

If tapering your opioid agonist therapy would likely not be a good option for you, your care provider may recommend continuing with your regular opioid agonist therapy. However, you always have the right to taper your opioid agonist therapy if you want to.

For Care Providers

When a person wishes to stop opioid agonist therapy, and if clinically appropriate, support them in a collaborative slow taper of opioid agonist therapy to discontinuation.

For Health Services

Ensure supports are in place to allow people on opioid agonist therapy to achieve improved mental health and social functioning. This will help people gain stability and provide an environment in which a collaborative slow taper to discontinuation is possible for appropriate people.

Quality Indicators

Process Indicators

Percentage of people who have achieved sustained stability on opioid agonist therapy who wish to discontinue opioid agonist therapy when it is clinically appropriate who are undergoing a taper off of their opioid agonist therapy

Denominator: total number of people with opioid use disorder who have achieved sustained stability who wish to discontinue opioid agonist therapy when it is clinically appropriate
Numerator: number of people in the denominator who are undergoing a taper off of their opioid agonist therapy
Data source: local data collection

Percentage of people who have decided to taper off of their opioid agonist therapy who are supported in a collaborative slow taper

Denominator: total number of people with opioid use disorder who have decided to taper off of their opioid agonist therapy
Numerator: number of people in the denominator who are supported in a collaborative slow taper (see definition)
Data source: local data collection

Definitions Used Within This Quality Statement

Collaborative slow taper

A collaborative slow taper is a period of about 12 months or longer during which a person works with their care provider to establish an appropriate rate for tapering. The person being treated has the right to stop tapering or reduce the rate of tapering at any point.

Clinically appropriate

Determining clinical appropriateness for tapering off of opioid agonist therapy includes considering the many factors that may reduce the risk of relapse following the taper; for example, duration of stability, duration of abstinence from substance use, absence of current or untreated psychiatric comorbidities, and the presence of strong supportive social networks.

Evidence to Improve Care