Buprenorphine/Naloxone for opioid dependence: Clinical practice guideline

A new clinical guideline released by the Centre for Addiction and Mental Health will help health care practitioners to provide buprenorphine (combined with naloxone), the most effective medication since methadone to treat the growing problem of opioid addiction in Canada.

While Buprenorphine has been available in Canada since 2007, partly due to the absence of clinical guidelines it has been underutilized, particularly by the frontline caregivers in under-resourced and remote communities who could use it most.

The evidence-based "Clinical Practice Guideline Buprenorphine/Naloxone for Opioid Dependence" provides clinical recommendations for the initiation, maintenance and discontinuation of buprenorphine/naloxone maintenance treatment for people dependant on opioids in Ontario.

The guideline was developed by a multidisciplinary committee including specialists in addiction medicine, family medicine and pharmacy from CAMH, the University of Toronto, St. Joseph's Health Centre, the Ontario College of Family Physicians, and the Northern Ontario School of Medicine.

"This guideline will help educate practitioners about improved patient access to treatment for opioid dependence, and safe prescribing and dispensing of buprenorphine/naloxone," said Dr. Peter Selby, Clinical Director of CAMH's Addictions Program. "It will also help policy makers understand the value of making this medication available to those battling an addiction to illegal opioids or prescription medication."

Studies have demonstrated that buprenorphine leads to more effective outcomes compared to detoxification alone, and, with the exception of retention in treatment, appears to be equally effective as methadone. Buprenorphine also has characteristics that appear to translate into less overdose risk when compared to methadone.

Opioid addiction, particularly dependence on prescription opioids—including OxyContin, Percocet/Percodan, Morphine, and Dilaudid—is an increasing clinical and public health problem in Canada. It has been estimated that only 25 per cent of Canadian opioid-dependent patients are in methadone maintenance treatment; particularly in certain provinces and in non-urban areas, access to treatment is quite limited.

While methadone is still an effective option for the treatment of opioid dependence, it is important that there are options for patients seeking treatment.

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