The guideline, published Monday in the Canadian Medical Association Journal, was created for a wide range of health-care providers to address the urgent need for treatment of opioid use that is causing a crisis of overdoses and deaths.
In 2016, there were 2,861 opioid-related deaths in Canada. As of last June, another 1,460 deaths had been attributed to the drugs and the total number for 2017 was predicted to reach about 4,000, fuelled by a combination of overprescribing by doctors and an influx of synthetic opioids, such as illicitly manufactured fentanyl and carfentanil.
“Opioid use disorder is a public health emergency nationwide and this guideline provides a blueprint for health practitioners to step up and provide evidence-based care,” said Dr. Julie Bruneau, a physician at the Universite de Montreal and lead author of the guideline.
The guideline recommends that Suboxone (buprenorphine-naloxone) be used as a first-line treatment whenever possible to reduce risk of toxicity and death.
Methadone not a first choice
The drug is used as a replacement for opioids to prevent severe withdrawal symptoms, but has a much safer side-effect profile than methadone, the medication traditionally prescribed for opioid addiction.
“In British Columbia, in about one in four prescription opioid overdose deaths, methadone is actually the culprit,” said Dr. Even Wood, director of the BC Centre on Substance Use and senior author of the guideline.