Reference guidelines

Opioid use disorders

A Guideline for the Clinical Management of Opioid Addiction (VCH)

Vancouver Coastal Health
Providence Health Care

This guideline endorses the use of buprenorphine/naloxone as a preferred first-line treatment for opioid addiction. This recommendation, the authors write, is in line with the growing body of research suggesting that buprenorphine is superior to methadone, mainly due to its lower overdose risk.

Diagnostic and Statistical Manual of Mental Disorders (DSM-V)

The DSM-5 is the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association (APA).

See the section Substance-Related and Addictive Disorders

To purchase a copy of the DSM-5, click here.

La buprénorphine dans le traitement de la dépendance aux opioïdes – Lignes directrices (juin 2009) [Buprenorphine in the treatment of opioid addiction – Guidelines (June 2009); available in French only]

The Collège des médecins du Québec (CMQ) and the Ordre des pharmaciens du Québec (OPQ)

These guidelines cover the pharmacology of buprenorphine; substitution treatment with buprenorphine or long-term therapy (eligibility criteria, medical and psychosocial assessment, treatment agreement and treatment plan); principles for the use of buprenorphine/naloxone for short- or long-term substitution treatment; urine testing; pharmaceutical services; choice of medication for the treatment of opioid addiction; changing substitution medication; chronic pain and opioid addiction; and other aspects of buprenorphine treatment.

Protocole de traitement de l’intoxication aiguë aux opioïdes [Protocol for the treatment of acute opioid overdose; available in French only]

Bulletin d'information toxicologique [Toxicology newsletter], Institut national de santé publique du Québec (INSPQ)

Opioids are a vast class of drugs that includes natural derivatives of the Papaver somniferum plant and semi-synthetic and synthetic compounds. Opioid overdose is common and can have serious, even fatal, consequences. These drugs mainly act on three large families of receptors: mu, delta and kappa. The classic opioid overdose triad consists of respiratory depression, decreased level of consciousness and miosis. Of these three, respiratory depression is responsible for the majority of morbidity and mortality associated with opioid overdose. Diagnosis of opioid overdose is primarily clinical and treatment involves maintaining an adequate airway and oxygenation and ventilation functions as well as the rational use of naloxone, a competitive mu receptor antagonist that can completely reverse the effects of opioid overdose. Monitoring, both for subjects exposed to an opioid who are initially asymptomatic and for subjects who require treatment with naloxone, is of the utmost importance and the best guarantee of safety in these circumstances.

Questionnaire pour une demande d’exemption pour la prescription de méthadone [Application for an exemption to prescribe methadone; available in French only]

Le Collège des médecins du Québec

  • Application for an exemption (physicians); available in French only
  • Application for a restricted exemption (medical residents); available in French only

Répertoire des compétences médicales en gestion de la douleur non cancéreuse et en prescription d’opioïdes [Directory of medical competencies for the management of non-cancer pain and opioid prescribing; available in French only]

Institut national de santé publique du Québec (INSPQ)

The INSPQ published, in collaboration with the Collège des médecins du Québec, the Université de Sherbrooke’s Faculty of Medicine and Health Sciences and CRAN, a directory of medical competencies for the management of non-cancer pain and opioid prescribing. This project, initiated by the Drug Strategy Community Initiatives Fund (DSCIF), has two objectives: to prepare a status report on medical practice and opioid prescribing and to meet the needs identified in the status report by organizing training for clinical physicians and future physicians.

Utilisation de la méthadone dans le traitement de la toxicomanie aux opiacés – Lignes directrices (octobre 1999) [Use of methadone in the treatment of opioid addiction – Guidelines (October 1999); available in French only]

Includes a modification to the guidelines as well as the policy on the use of methadone capsules (2004).

The Collège des médecins du Québec (CMQ) and the Ordre des pharmaciens du Québec (OPQ)

These guidelines cover the mechanism of action of methadone; methadone maintenance treatment or long-term therapy (eligibility criteria, medical and psychosocial assessment, treatment agreement, treatment plan); urine testing; pharmaceutical services; pain treatment and the methadone program; psychiatric comorbidities; certain administrative aspects associated with methadone prescribing (e.g., specific exemption), etc.

Chronic pain

American Society of Addiction Medicine: National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use (June 2015)

American Society of Addiction Medicine: National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use

This guideline was developed to provide information on evidence-based treatment of opioid use disorder for clinicians who prescribe pharmacotherapy.

CDC Guideline for Prescribing Opioids for Chronic Pain – United States, 2016

Centers for Disease Control and Prevention

Published in March 2016, the new Centers for Disease Control and Prevention guideline provides recommendations for physicians regarding the safe prescribing of opioids for chronic pain management.

CDC Guideline

Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain (National Opioid Use Guideline Group)

Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain (National Opioid Use Guideline Group – NOUGG) 

Created in 2007, the Guideline Group is a collaboration of provincial and territorial medical regulatory authorities under the umbrella of the Federation of Medical Regulatory Authorities of Canada. The guideline on the use of opioids for the treatment of chronic non-cancer pain is currently being updated under the stewardship of the National Pain Centre at McMaster University in Hamilton.

Douleur chronique et opioïdes, l’essentiel [Chronic pain and opioids: what you need to know; available in French only]

Collège des médecins du Québec

In these guidelines, the Collège des médecins du Québec provides a reference framework for physicians who administer opioids to patients with chronic non-cancer pain, especially pain that does not respond to the usual treatment options.

Integrated university health networks (Réseaux universitaires intégrés de santé – RUIS)

Four networks are affiliated with Université Laval, McGill University, the Université de Montréal and the Université de Sherbrooke, respectively. The integrated university health networks were created to promote collaboration, complementarity and the integration of the health care, teaching and research missions of health institutions with a university designation and the universities they are affiliated with.

Interagency Guideline on Prescribing Opioids for Pain

Washington State Agency Medical Directors’ Group (AMDG)

This guideline is designed as an easy-to-use reference for primary care clinicians. Each section includes a list of clinical recommendations supported by scientific evidence. A number of resources are provided in the appendices.

Inventory of Guidelines on the Treatment of Harms Resulting from Prescription Drug Use, March 2015

Centre for Addiction and Mental Health (CAMH), Government of Nova Scotia, Canadian Centre on Substance Abuse (CCSA)

This site provides access to extensive information on provincial guidelines on methadone maintenance treatment programs, withdrawal management, prescription drug misuse and other opioid use disorders, and pain relief.