Opioid Use Disorder

Opioid use disorder (OUD) is a treatable disorder marked by a problematic pattern of opioid use that causes clinically significant impairment or distress. Tolerance and physical dependence can occur during appropriate prescribed opioid therapy and do not, by themselves, establish OUD. The assessment therefore centres on loss of control, craving, hazardous use, continued use despite harm, role impairment and related diagnostic features rather than stigma or assumptions about a person who takes an opioid. Medication is the foundation of treatment for many people. The current Canadian national guideline places buprenorphine and methadone together as standard first-line opioid agonist treatment (OAT) options. Slow-release oral morphine is a second-line option. Choice between first-line options is shared with the patient and accounts for treatment goals, previous experience, clinical risks, access and preference. Withdrawal management alone should not be offered as definitive treatment because return to use, morbidity and mortality are increased; continuing addiction care is required. Psychosocial treatment may improve retention and can be offered alongside OAT, but it must not be a condition of access to medication. Harm reduction remains part of...