This guideline uses the term “family” to encompass all relationships that are important to the patient, which may include romantic partners, close friends, and other people of significance who may or may not be legally recognized as family. Family members can have an important role as partners in an individual patient’s care, and should be included in decision-making processes and care at all levels, when deemed appropriate by patients and their care teams. Research has shown that families can have a pivotal role in improving treatment outcomes and sustaining benefits of treatment for substance use among youth and adults by providing additional support and structure and promoting resilience.96-99 If a patient determines family involvement would be a positive element in their treatment plan, clinicians are encouraged to educate family members about available treatment options and resources, and provide as much patient-specific information as possible within the boundaries of confidentiality requirements. Family members involved in the care of patients are often an important source of information about the patient’s clinical history and progress; this information should be recorded and utilized in the care planning process as appropriate.

As with all medical care, confidentiality requirements must be met when treating individuals with OUD.  This includes maintaining confidentiality from family members unless patients have granted consent for their medical information to be shared with their family.100 Health care providers should avoid making assumptions about privacy and routinely ask patients if they prefer to include family members or friends as supportive partners in their care. If aspects of care are being kept confidential from family members, the challenges and logistics of this should be discussed with the patient. While information about a person cannot be shared with family members without a patient’s explicit consent, family members can share relevant information with health care providers without violating that patient’s privacy or confidentiality. A clinician can also provide education and support to a family without disclosing any information about an individual. 

It is important to note that, in some cases, family involvement may not be in the best interest of the patient. Factors such as partner or parental substance use, familial abuse and violence, or dysfunctional family relationships can act as barriers to engagement and retention in treatment as well as to achieving long-term recovery.96,98,99,101 Patients should be given full discretion on whether and how they wish to include family members in their care, and if they opt not to involve family members, this decision should be respected.

In the case of youth (aged 12–25), parental participation in treatment should be actively encouraged, if appropriate, and family members should be supported with sufficient education and information about opioid use and OUD. Offering or providing referrals to group or individual sessions for parents and/or caregivers is recommended. A family history should be taken, when possible, to identify and address any mental health or substance use issues requiring treatment in the youth’s family. It should also be noted that, like adults, not all youth have healthy or positive relationships with their family members. Decisions to involve family members in care should be guided by the patient’s wishes and an understanding of the family dynamic. Further youth-specific guidance on family involvement in care can be found in Treatment of Opioid Use Disorder for Youth—Guideline Supplement.102

Regardless of their level of involvement in a patient’s care, family members and caregivers often require support for their own health and wellness. Several resources exist for family members impacted by opioids and OUD, including From Grief to Action’s Coping Kit: A guide for family members; Parents Forever, a support group for parents of adults with substance use issues in Vancouver, BC; Nar-Anon Family Groups across BC; and Here to Help’s resources for family members. Further information and resources can also be found at the BCCSU’s Family and Caregiver Resources page. Family members can also be referred to external specialist-led and community-based services and supports. Clinicians should be mindful of any concerns that patients may have about privacy, confidentiality, or perceived conflicts of interest if patients and family members are referred to the same specialist-led or community-based programs.