Opioid Addiction Should be Treated with Medication - Says New Medical Guideline

New Canadian guidelines as of 2018 list the best strategies for treating opioid addiction, with an emphasis on using medically managed treatment with buprenorphine-naloxone before trying other options. The recommendations were carefully researched and published to help health care providers address the need for treatment recommendations for opioid use and addiction, which frequently lead to overdose and death.

As of 2016, the death rate of opioid related Canadian deaths was 7.9 per 100,000 individuals and rising. This epidemic affects both the U.S. and Canada and is supported by both the illegal drug trade and medical providers over prescribing opioid medications.

The panel that did the research was composed of over 40 Canadian health care providers. The group also consisted of individuals with experience treating opioid addiction, and carefully considered the values and preferences of patients as it made its recommendations for the study.

These recommendations included: 

Begin treating with buprenorphine-naloxone when medical providers are able, as soon as possible. This helps to limit the risk of toxicity, illness, and death.

Individuals who have an allergy to or who respond badly to buprenorphine-naloxone should be treated with methadone instead.

If buprenorphine-naloxone is not a reasonable option, begin opioid agonist treatment with methadone instead.

Individuals who respond well to methadone, but who are in need of treatment that is simpler to maintain should consider a transition to buprenorphine-naloxone.

Individuals who are nonresponsive to these treatments may want to consider oral morphine in slow release form, given as daily witnessed doses.

Keep patients focused on a goal of long-term treatment, as opposed to a cycle of only withdrawal avoidance, to help reduce their risk of eventual relapse and possible death from overdose.

Buprenorphine-naloxone has a better safety record for the following reasons: 

• smaller risk of overdose
• smaller risk of suppressed breathing
• easier to use,especially if clinics are not available for supervised dosing
• flexible dosing
• mild symptoms if treatment is stopped

The new guidelines also discuss how offering treatment only as a way to manage withdrawals can actually dramatically boost the national overdose rate. Patients wind up with a goal of simply minimizing their immediate discomfort, instead of working towards a long term goal of recovery. They then wind up relapsing, taking the opioids or illicit drugs at the same dose they were previously familiar with taking. However, because their tolerance level has lowered in the time that they’ve been drug-free, they accidentally overdose.

If, instead, patients work towards a goal of becoming drug-free for the rest of their life, it becomes a long term goal that they can focus on, instead of a shorter term one.

Opioid dependence can become a relapsing condition that is chronic over one's lifetime, with dramatically increased risk of shortened lifespan and death. However, if an individual is able to obtain appropriate treatment and follow through with the same, reaching a long-term recovery is possible.

The team recommends next steps for health providers included recognizing and observing chronic pain disorders, and finding ways to manage opioid use in pain patients to avoid addiction, reducing the amount of stigma that goes along with disorders such as substance abuse, increasing the access to addiction treatment services, and expanding access to opioid agonists.