Canadian researchers published updated national guidelines for opioid use disorder treatment, establishing methadone and buprenorphine as equal first-line treatment options.
Canadian opioid-related deaths increased from 2,831 in 2016 to 8,049 in 2023.
The Canadian Research Initiative in Substance Matters (CRISM) based their eight recommendations on systematic reviews of literature published between January 2017 and September 2023. Meta-analyses showed both medications reduced mortality risk by half compared with no treatment
The data revealed distinct patterns for each medication:
- Buprenorphine showed higher attrition rates after the first month of treatment
- Methadone showed higher mortality risk during the first month of treatment compared with subsequent months.
The guidelines, published in CMAJ, positioned slow-release oral morphine as a second-line treatment option, removing previous requirements for special exemptions to prescribe it.
The development process included:
- 20-member development committee including addiction medicine experts
- 63-member external review committee
- Systematic review following PRISMA guidelines
- Quality assessment using GRADE, AMSTAR-2, Cochrane RoB-2, ROBINS-I, and Newcastle-Ottawa Scale
- Three rounds of review and consensus.
For pregnant patients, the guidelines did not recommend one medication over another, citing limited precision in neonatal exposure data.
The researchers noted no randomized controlled trials comparing slow-release oral morphine with other opioid agonist therapy had been published in the past decade.
CRISM planned to distribute the guidelines through social media, press releases, podcasts, and webinars, with training sessions for professionals and patients.
Conflict of interest disclosures can be found in the guidelines.
