Land Acknowledgement

The British Columbia Centre on Substance Use would like to respectfully acknowledge that the land on which we work is the unceded territory of the Coast Salish Peoples, including the traditional territories of xʷməθkwəy̓əm (Musqueam), Sḵwx̱wú7mesh (Squamish), and səl̓ílwətaɬ (Tsleil-Waututh) Nations.

We recognize that the ongoing criminalization, institutionalization, and discrimination against people who use drugs disproportionately harm Indigenous Peoples, and that continuous efforts are needed to dismantle colonial systems of oppression. We are committed to the process of reconciliation with Indigenous Peoples, and recognize that it requires significant and ongoing changes to the health care system.

We hope that this guideline contributes to a system of substance use care that provides safe, respectful, evidence-based care.

Acknowledgments 

The Guideline Committee gratefully acknowledges Nirupa Goel and Christina Chant for their supervisory support and editorial contribution. The committee also wishes to acknowledge Averill Hanson, Trish Emerson, and Delaney Lewis for their coordination of the development of the guideline, as well as Ashley Cole for facilitating guideline review and consultation sessions with community members with lived and living experience, and Corinna Chase and Marcia Mejia for coordinating consultation with the Indigenous community members. The committee would like to thank Ashley Goodman for her review of the Indigenous Peoples section, Andrew Kestler and Isabelle Miles for their review of the Emergency Department appendix, and Trevor Goodyear and Rod Knight for their review of the 2SLGBTQIA+ section. The committee would also like to thank Mary-Doug Wright, and Mojan Fazelipour for developing systematic literature search strategies and performing literature search activities. Additionally, the committee is grateful to Katrina Hsu, Jordan Sang, Winnie So, and Ali Zapernick for their research and editorial support. The committee thanks Kevin Hollett and Anjali Tarrant for design and communications support, and Warren O’Briain for communications and policy guidance. Finally, the committee acknowledges the immense foundational work undertaken by Emily Wagner, the medical writers for the first edition of A Clinical Guideline for the Management of Opioid Use Disorder.

This work was made possible by funding provided to BCCSU by the Province of British Columbia.

Authors and Contributors

Medical Writers 

Maryam Babaei, MSc; Senior Medical Writer, British Columbia Centre on Substance Use

Jessica Bright, MPH; Manager, Medical Writing Team, British Columbia Centre on Substance Use

Committee Co-Chairs

Paxton Bach, MD, MSc, ABIM, FRCPC, FASAM; Co-Medical Director, British Columbia Centre on Substance Use; Clinical Assistant Professor, Department of Medicine, University of British Columbia

Rupinder Brar, MD, CCFP(AM), CISAM; Medical Director, Regional Addiction Program, Vancouver Coastal Health; Clinical Assistant Professor, Department of Family Medicine, University of British Columbia; Physician, PHS Community Services Society; Physician, Addition Medicine Consult Team, St Paul's Hospital

Emma Garrod, RN, MSN; Clinical Nurse Specialist, The First Nations Health Authority; Co-Director, Addiction Nursing Fellowship, British Columbia Centre on Substance Use

Committee Members

Deb Bailey, MA, RCC; Family engagement committee member, British Columbia Centre on Substance Use

Georgina K. Chipman, BSc(Pharm) RPh; Locum Community Pharmacist, Georgina's Pharmacy Services Ltd. at Shoppers Drug

Jessica Cooksey, PWLLE, MA, CCS-AC, ICADC, CCAC; Director of Operations, The Last Door Recovery Society; Board Member, British Columbia Addiction Recovery Association

Nicole Cowan, RN, BSN; Co-Director, Addiction Nursing Fellowship, British Columbia Centre on Substance Use; Clinical Nurse Specialist, Vancouver Community Specialized Substance Use Services, Vancouver Coastal Health

Tracey Day, DNP, NP(F); Clinical Advisor, Overdose Emergency Response Centre, Ministry of Mental Health and Addictions; Clinical Director, Substance Use and Addiction Services, Carrier Sekani Family Services; Adjunct Professor, School of Health Sciences, University of Northern British Columbia

Cassandra Djurfors, MD, CCFP(AM), FCFP; Family Physician, Vancouver Coastal Health

Roland Engelbrecht, MB, ChB, Dip PEC(SA), CCFP(AM), ISAM(cert); Director, The Cornerstone Clinic, Hospitalist & Chief of Staff, Cariboo Memorial Hospital, Board Member, Canadian Alcohol Use Disorder Society

Nadia Fairbairn, MD FRCPC MHSc cISAM; Philip Owen Professor in Addiction Medicine, University of British Columbia; Assistant Professor, Division of Social Medicine, Department of Medicine, University of British Columbia; Clinician Scientist, British Columbia Centre on Substance Use; Scholar, Michael Smith Foundation for Health Research/St. Paul's Hospital Foundation; Medical Director (Interim), Regional Addiction Program, Vancouver Coastal Health

Nikhil Gandhi, BScPhm, RPh; Clinical Pharmacist, Mental Health Substance Use, First Nations Health Authority

Ashley Heaslip, MD, CCFP, MPH, dISAM, PhD(C); Regional Medical Director, Addiction Medicine, Island Health

Theo Jankowski, MD FRCPC; Addiction Medicine Physician, Addiction Medicine Consult Service, Royal Jubilee Hospital; General Internist, Island Health; Clinical Instructor, University of British Columbia

Mona Kwong, BSc(Pharm), PharmD, MSc, MPA; Director, Addictions Pharmacy Fellowship Program, British Columbia Centre on Substance Use; Pharmacy Advisor, British Columbia Centre on Substance Use; Clinical Pharmacist and Manager, Pharmasave Howe Street; Clinical Consultant Pharmacist, Infinity Medical Specialists Clinic; Clinical Instructor, Faculty of Pharmaceutical Sciences, University of British Columbia

Leslie Lappalainen, MC, CCFP(AM); Addiction Medicine Consultant, Kelowna General Hospital; Medical Lead for Addiction Medicine, Interior Health

Tifaine Magnusson, BSc(Pharm), ACPR, APF; Clinical Pharmacist, Virtual Health Addiction Clinic / Mental Health and Substance Use Services, Fraser Health

Jenny McDougall, PWLLE; Co-Founder of Coalition of Substance Users of the North (CSUN); Founder & Lead of Prescription Alternative Advocacy Program, CSUN; Board Member, Pacific Aids Network; Member, Peer Engagement and Evaluation Project (PEEP); Peer Research Assistant, Canadian Institute for Substance Use Research

Douglas W.R. McTaggart, BComm, MD; Medical Consultant, Guidelines and Protocols Advisory Committee

Jessica Mensinger, MSW, RSW; Clinical Operations Manager, Mental Health and Substance Use Services, Interior Health; Co-Director Addiction Social Work Fellowship Program, British Columbia Centre on Substance Use

Daniel Paré, MD CCFP(AM) DABAM CCSAM FASAM; Family Physician, Vancouver Coastal Health; Clinical Instructor, Department of Family Practice, University of British Columbia

Simran Riarh, RPN; Clinical Nurse Educator, Mental Health and Substance Use Services, Fraser Health

Josey Ross, MA; Associate Director, Education and Clinical Activities, British Columbia Centre on Substance Use

Andrea Ryan, MD, CCFP(AM), DRCPSC; Medical Director, Addiction Medicine, Providence Health Care; Medical Director, Road to Recovery, Providence Health Care; Addiction Consultant, Providence Health Care; Clinical Instructor, Department of Family Medicine, University of British Columbia
Vijay Seethapathy, MBBS, MRCPsych, FRCPC, MBA (Exec); Chief Medical Officer, British Columbia Mental Health and Substance Use Services

Laura Shaver, PWLLE; President, British Columbia Association of People on Opiate Maintenance (BCAPOM), The Vancouver Area Network of Drug Users (VANDU); Peer Advocacy Navigator for the OAT and the iOAT program, British Columbia Centre on Substance Use

Chase Simms, MPH, BA; Research Officer, Guidelines and Protocols Advisory Committee

Christy Sutherland, MD CCFP (AM) dABAM; Medical Director, PHS Community Services Society; Clinical Associate Professor, Department of Family Medicine, University of British Columbia 
Kenneth Tupper, PhD; Director, Substance Use Prevention and Harm Reduction, British Columbia Ministry of Health

Sharon Vipler, MD, CCFP (AM), dipl.ABAM, DRCPSC; Program Medical Director & Regional Department Head, Department of Addiction Medicine and Substance Use Services, Fraser Health; Clinical Associate Professor, Department of Family Medicine, University of British Columbia

External Review Panel 

Lisa A. Bromley, MD, CCFP(AM), FCFP; Community OAT Prescriber, Sandy Hill Community Health Centre; Medical Director, Substance Use Program, The Ottawa Hospital

Alexis Crabtree, MD, MPH, PhD, CCFP, FRCPC; Public Health Physician, British Columbia Centre for Disease Control

Amanda Lavigne, RPN, BScPN; Substance Use Clinical Nurse Specialist, Interior Health Authority

Nickie Mathew, MD, ABPN, FRCPC, ABPM; Medical Director, Complex Concurrent Disorders, Provincial Health Services Authority

Annabel Mead, MBBS, FAChAM, DABAM; Assistant Clinical Professor, University of British Columbia; Senior Medical Director, Provincial Health Services Authority

Rebecca Regan, RSW, BSW, MSW Student; Social Worker, PHS Community Services Society; Social Worker, Vancouver Coastal Health; Mental Health Worker, Insite

Alexander Y. Walley, MD, MSc; Professor of Medicine, Boston University Chobanian & Avedisian School of Medicine; Attending Physician, Boston Medical Center; Medical Director, Bureau of Substance Addiction Services, Massachusetts Department of Public Health

Jennifer Wyman, MD, FCFP, DABAM, MPH; Medical Director, Women's College Hospital Substance Use Service; Medical Educator, META:PHI; Assistant Professor, Department of Family and Community Medicine, University of Toronto

Community Reviewers

Indigenous Advisory Group
Reviewed by an Elder and four community members

BCCSU Family Members Group
Reviewed by family members of people with lived and living experience

BCCSU People with Lived and Living Experience Committee
Reviewed by representatives of this Committee, including:

Mazal Jensen
Haleigh Marie 
Jenny-Leigh McDougall
Tanis Rose Oldenburger
Dean Wilson