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Practice Guideline
. 2018 Mar 5;190(9):E247-E257.
doi: 10.1503/cmaj.170958.

Management of opioid use disorders: a national clinical practice guideline

Julie Bruneau  1 , Keith Ahamad  2 , Marie-Ève Goyer  2 , Ginette Poulin  2 , Peter Selby  2 , Benedikt Fischer  2 , T Cameron Wild  2 , Evan Wood  2 ; CIHR Canadian Research Initiative in Substance Misuse
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Practice Guideline

Management of opioid use disorders: a national clinical practice guideline

Julie Bruneau et al. CMAJ. .
No abstract available

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Conflict of interest statement

Competing interests: Julie Bruneau, Benedikt Fischer, T. Cameron Wild, and Evan Wood report grants from the Canadian Institutes of Health Research (CIHR) during the conduct of the study. Peter Selby reports grants from CIHR to the Centre for Addiction and Mental Health during the conduct of the study. Peter Selby conducted an expert review for the Canadian Agency for Drugs and Technologies in Health on a rapid analysis for a formulation of buprenorphine in the last 12 months. Marie-Ève Goyer reports payments from Indivior, Gilead Sciences, ViiV Healthcare and Merck, outside of the submitted work. Julie Bruneau reports monetary compensation as advisor from Gilead and Merck, outside of the submitted work. No other competing interests were declared.

Figures

Figure 1:
Figure 1:
Treatment algorithm for opioid use disorder. Note: A particular medication may not be indicated for a variety of reasons, including ineffectiveness or medical contraindication, comorbidities, drug–drug interactions, patient preference and specific circumstances, and prescriber’s experience. Any treatment for opioid use disorder, but particularly slow agonist tapers, should incorporate evidence-based psychosocial interventions with qualified professionals, motivational interviewing, long-term monitoring of substance use, provision of comprehensive primary care, and referrals to psychosocial treatment interventions and psychosocial supports as appropriate, with specialist care as required, to optimize physical and mental wellness as the patient progresses in recovery. Withdrawal management (formerly “detoxification”) without linkage to long-term addiction treatment is to be avoided, and patients desiring such approach should be informed of risks and encouraged toward other treatment options that would suit their circumstances. DSM-5 = Diagnostic and Statistical Manual of Mental Disorders, fifth edition.
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