The continuum of care for OUD includes evidence-based pharmacotherapies, psychosocial supports and interventions, and recovery support services. Individuals with OUD may need or want to try multiple approaches of varying intensity along this continuum of care, as their needs, circumstances, and goals change, in order to reduce harm, improve health and quality of life, and support long-term recovery.
This guideline supports the use of a stepped and integrated approach, in which treatment options are continually adjusted to meet changing patient needs, circumstances, and goals. A stepped approach may include treatment intensification, transitions between different treatment options, and strategies to de-intensify treatment at the patient’s discretion. Patients can opt to re-initiate pharmacotherapy, psychosocial treatment, or recovery supports at any time if their needs or circumstances change.
Primary care providers and care teams should ensure that patients with OUD and their families are aware of the range of community-based and, where relevant, specialist-led programs and services that are available to them, and regularly assess interest or readiness in accessing these services. To support continuity of—and transitions in—care across the continuum, primary care providers and care teams should establish fully functioning referral pathways. Establishing protocols for communication and sharing information, with the patient’s consent, between the primary care team and referral partners is strongly encouraged.
2.8.1 Longitudinal Care
Approaches to care and management of OUD have traditionally emphasized short-term and high-intensity treatment; for example, referring patients to inpatient withdrawal management or inpatient treatment programs without a plan for continuing care after discharge or completion. However, over the past two decades, there has been a greater understanding of OUD as a chronic, relapsing condition, which, like other chronic conditions, is best treated in a longitudinal fashion.
Although sometimes requiring specialist consultation, OUD is often best managed in outpatient primary care settings, using a longitudinal care approach in which patients have multiple opportunities to engage in care, patient need and preferences regarding treatment are prioritized, and counselling, social supports, and mental health services are incorporated into care.93,94 A pre-existing therapeutic relationship (or the development of one over time) can improve engagement and retention in care.94