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Background: In an evolving landscape of practices and policies, reviewing and incorporating the latest scientific evidence is necessary to ensure optimal clinical management for people with opioid use disorder. We provide a synopsis of the 2024 update of the 2018 National Guideline for the Clinical Management of Opioid Use Disorder, from the Canadian Research Initiative in Substance Matters. Methods: For this update, we followed the United States Institute of Medicine's Standards for Developing Trustworthy Clinical Practice Guidelines and used the Appraisal of Guidelines Research and Evaluation—Recommendation Excellence tool to ensure guideline quality. We carried out a comprehensive systematic literature review, capturing the relevant literature from Jan. 1, 2017, to Sept. 14, 2023. We drafted and graded recommendations according to the Grading of Recommendations, Assessments, Development and Evaluation approach. A multidisciplinary external national committee, which included people with living or lived experience of opioid use disorder, provided input that was incorporated into the guideline. Recommendations: From the initial 11 recommendations in the 2018 guideline, 3 remained unchanged, and 8 were updated. Specifically, 4 recommendations were consolidated into a single revised recommendation; 1 recommendation was split into 2; another recommendation was moved to become a special consideration; and 2 recommendations were revised. Key changes have arisen from substantial evidence supporting that methadone and buprenorphine are similarly effective, particularly in reducing opioid use and adverse events, and both are now considered preferred first-line treatment options. Slow-release oral morphine is recommended as a second-line option. Psychosocial interventions can be offered as adjunctive treatment but should not be mandatory. The guideline reaffirms the importance of avoiding withdrawal management as a standalone intervention and of incorporating evidence-based harm reduction services along the continuum of care. Interpretation: This guideline update presents new recommendations based on the latest literature for standardized management of opioid use disorder. The aim is to establish a robust foundation upon which provincial and territorial bodies can develop guidance for optimal care. [ABSTRACT FROM AUTHOR]

Background: In an evolving landscape of practices and policies, reviewing and incorporating the latest scientific evidence is necessary to ensure optimal clinical management for people with opioid use disorder. We provide a synopsis of the 2024 update of the 2018 National Guideline for the Clinical Management of Opioid Use Disorder, from the Canadian Research Initiative in Substance Matters., Methods: For this update, we followed the United States Institute of Medicine's Standards for Developing Trustworthy Clinical Practice Guidelines and used the Appraisal of Guidelines Research and Evaluation-Recommendation Excellence tool to ensure guideline quality. We carried out a comprehensive systematic literature review, capturing the relevant literature from Jan. 1, 2017, to Sept. 14, 2023. We drafted and graded recommendations according to the Grading of Recommendations, Assessments, Development and Evaluation approach. A multidisciplinary external national committee, which included people with living or lived experience of opioid use disorder, provided input that was incorporated into the guideline., Recommendations: From the initial 11 recommendations in the 2018 guideline, 3 remained unchanged, and 8 were updated. Specifically, 4 recommendations were consolidated into a single revised recommendation; 1 recommendation was split into 2; another recommendation was moved to become a special consideration; and 2 recommendations were revised. Key changes have arisen from substantial evidence supporting that methadone and buprenorphine are similarly effective, particularly in reducing opioid use and adverse events, and both are now considered preferred first-line treatment options. Slow-release oral morphine is recommended as a second-line option. Psychosocial interventions can be offered as adjunctive treatment but should not be mandatory. The guideline reaffirms the importance of avoiding withdrawal management as a standalone intervention and of incorporating evidence-based harm reduction services along the continuum of care., Interpretation: This guideline update presents new recommendations based on the latest literature for standardized management of opioid use disorder. The aim is to establish a robust foundation upon which provincial and territorial bodies can develop guidance for optimal care., Competing Interests: Competing interests: Igor Yakovenko reports receiving research assistant payments from the Canadian Research Initiative in Substance Matters (CRISM), in support of the present manuscript. Dr. Yakovenko also received payment from CRISM to cover travel expenses to a CRISM annual meeting in 2022 to present the proposed project, outside the submitted work. Paxton Bach reports receiving a salary from the British Columbia Centre on Substance Use for leadership work as a co–medical director (which includes the development of clinical guidance and contribution to educational activities in this area), outside the submitted work. Ginette Poulin reports receiving honoraria for presentations from the Master Clinician Alliance and Indivior, outside the submitted work. Peter Selby reports holding the role of Past Chair of the Medical Education Committee, American Society of Addiction Medicine (unpaid), outside the submitted work. Marie-Ève Goyer reports receiving public funding from the Québec Ministry of Health to the Clinical and Organizational Support Team, which produces tools and guidelines, including on opioid agonist therapy (OAT); Dr. Goyer is also under contract with a public entity, Institut National de Santé Publique du Québec, to guide training on OAT to health care professionals, and has received consulting fees from Médecins du Monde France for serving as an expert in Burundi to develop OAT guidelines, and in Tanzania on the clinical aspects of a research project on long-acting buprenorphine (all outside the submitted work). Jürgen Rehm reports receiving a grant from the Canadian Institutes of Health Research (CIHR), paid to the Centre for Addiction and Mental Health, for the Ontario Canadian Research Initiative Node Team CRISM Phase II Application, outside the submitted work. Evan Wood is a physician who works for Vancouver Coastal Health in the area of withdrawal management and undertakes work in the area of occupational addiction medicine. Dr. Wood is also a professor of medicine based at the University of British Columbia (UBC), a position supported by a CIHR Tier 1 Canada Research Chair, and has received salary support from an R01 from the US National Institute on Drug Abuse, paid to UBC. Dr. Wood’s research laboratory is further supported by CIHR grants to CRISM. Dr. Wood has also undertaken consulting work in legal matters related to substance use disorders and for a mental health company called Numinus Wellness, where Dr. Wood is former chief medical officer; Dr. Wood has also received compensation in the form of equity in Numinus. Dr. Wood reports receiving honoraria for non-industry-related lectures and presentations (e.g., at academic or educational conferences), including a talk at the Canadian Society of Addiction Medicine (CSAM) paid by the CSAM conference; a Rounds Presentation at Dalhousie University (paid by the university); and an educational talk for the allied health educational platform, Executive Links (all outside the submitted work; none involved funding from the pharmaceutical industry). Dr. Wood has also received payment for expert reports and expert testimony in legal matters pertaining to substance use disorder, including from the Canadian Medical Protective Association and from trade unions representing workers with possible substance use disorder. Dr. Wood has received travel support from the CIHR. Julie Bruneau reports receiving a CIHR research grant and a grant from Health Canada’s Substance Use and Addictions Program research program (in support of the present manuscript; both grants were paid to CRISM). Outside the submitted work, Dr. Bruneau has received a National Institutes of Health (NIH) Research Grant and an NIH Grant from Simon Fraser University (paid to Dr. Bruneau directly). Dr. Bruneau has received consulting fees as a member of advisory boards for Gilead Sciences and AbbVie, payment from Simon Fraser (NIH Grant) as a research clinical advisor (paid to Dr. Bruneau directly), an honorarium for a presentation to Gilead Sciences, and support for attending meetings from a CIHR Research Grant, paid to CRISM. Dr. Bruneau has also served as an expert in a brief for court in Alberta (to clarify the rationale for the Grading of Recommendations, Assessments, Development and Evaluation of 1 recommendation of the injectable opioid agonist therapy guidelines [in 2021; affidavit]); Dr. Bruneau has been conducting research for the past 30 years on topics related to prevention and care for people who use drugs. No other competing interests were declared., (© 2024 CMA Impact Inc. or its licensors.)