| Recommendation | Quality of evidence | Strength of recommendation | Relevant evidence review sections | |
| Pharmacological Treatment | ||||
| 1 | Adults with opioid use disorder should be offered opioid agonist treatment as the standard of care. | High | Strong |
Section 3.2 Section 3.2.ix (Remarks) |
| 2 |
Prescribers should work with each patient to determine which of the following opioid agonist treatment medications is most appropriate based on the patient’s circumstances, goals, and previous treatment experiences.
|
High | Strong |
Section 3.2.i |
| High | Strong | Section 3.2.ii | ||
| Moderate | Strong | Section 3.2.iii | ||
| 3 | Transition between opioid agonist treatment medications should be facilitated if indicated by clinical circumstances or patient preference. | Low | Strong | Section 3.2.iv Section 3.2.ix (Remarks) |
| 4 | Patients stable on 8mg-24mg sublingual buprenorphine/ naloxone may be offered the monthly extended-release formulation of buprenorphine if indicated by patient preference or circumstances. | Low | Strong | Section 3.2.i (Extended-release buprenorphine) Section 3.2.ix (Remarks) |
| 5 | Injectable opioid agonist treatment with diacetylmorphine or hydromorphone should be considered for adults with severe opioid use disorder and ongoing unregulated injection opioid use who have not benefitted from, or have declined, oral options for opioid agonist treatment. | Moderate | Weak (Conditional) | Section 3.2.vii Section 3.2.ix (Remarks) |
| 6 | Opioid agonist treatment should be viewed as an open-ended treatment. However, if a patient wishes to discontinue medication following a sustained period of stability on opioid agonist treatment (12 months or more), a slow taper should be offered. | Moderate | Strong | Section 3.2.viii Section 3.2.ix (Remarks) |
| 7 | For adults who choose to discontinue OAT, a relapse prevention plan should be collaboratively developed and implemented after a discussion of both pharmacological and non-pharmacological options. | Low | Strong | Section 3.2.viii Section 3.2.ix (Remarks) |
| 8 | Oral naltrexone is not a recommended treatment for adults with opioid use disorder. However, it may be offered to individuals who have declined or discontinued OAT and would prefer non-opioid treatment. | Low | Weak (Conditional) | Section 3.3.i Section 3.3.iii (Remarks) |
| 9 | While extended-release naltrexone is not currently available in Canada, it is an evidence-based treatment that may be considered for patients with opioid use disorder who are not interested in OAT. | Moderate | Weak (Conditional) | Section 3.3.ii Section 3.3.iii (Remarks) |
| Non-Pharmacological Treatment | ||||
| 10 | Withdrawal management alone (including rapid opioid agonist tapers) without transition to opioid agonist treatment is not recommended. | Moderate | Strong | Section 3.4 Section 3.4.vi (Remarks) |
| 11 | If the patient chooses to pursue withdrawal management (e.g., slow opioid agonist taper), this should be conducted in an outpatient setting, followed by a collaboratively developed relapse prevention plan and referral to long-term psychosocial treatment and support. | Moderate | Strong | Sections 3.4.iv–3.4.vi |
| 12 | Psychosocial treatment interventions and supports should be routinely offered to adults with opioid use disorder, in conjunction with pharmacological treatment. | Moderate | Strong | Section 3.5 (3.5.i–3.5.iii) |
| Harm Reduction | ||||
| 13 | Conversations about safer drug use, take-home naloxone, and referral to other harm reduction services should be routinely offered as part of standard care for individuals with opioid use disorder. | Moderate | Strong | Section 3.7 (3.7.i–3.7vi) |