Canadian Guidelines on Opioid Use Disorder Among Older Adults

Abstract

BackgroundIn Canada, rates of hospital admission from opioid overdose are higher for older adults (≥ 65) than younger adults, and opioid use disorder (OUD) is a growing concern. In response, Health Canada commissioned the Canadian Coalition of Seniors’ Mental Health to create guidelines for the prevention, screening, assessment, and treatment of OUD in older adults.MethodsA systematic review of English language literature from 2008–2018 regarding OUD in adults was conducted. Previously published guidelines were evaluated using AGREE II, and key guidelines updated using ADAPTE method, by drawing on current literature. Recommendations were created and assessed using the GRADE method.ResultsThirty-two recommendations were created. Prevention recommendations: it is key to prioritize non-pharmacological and non-opioid strategies to treat acute and chronic noncancer pain. Assessment recommendations: a comprehensive assessment is important to help discern contributions of other medical conditions. Treatment recommendations: buprenorphine is first line for both withdrawal management and maintenance therapy, while methadone, slow-release oral morphine, or naltrexone can be used as alternatives under certain circumstances; non-pharmacological treatments should be offered as an integrated part of care.ConclusionThese guidelines provide practical and timely clinical recommendations on the prevention, assessment, and treatment of OUD in older adults within the Canadian context.

Problematic Opioid Use Among Older Adults: Epidemiology, Adverse Outcomes and Treatment Considerations

“…Given the concerns related to problematic opioid use in this population, it is important to have an approach to screening and diagnosis. As per Canadian and British guidelines, all older adults presenting to clinical services should be screened for substance use and substance use disorders [ 33 , 34 ]. Unfortunately, there are no validated screening tools for OUD in this population [ 33 ].…”

“…A physical examination should also be completed, examining for signs of intoxication, withdrawal and physical sequelae (e.g. injuries related to falls) [ 1 , 34 ]. Laboratory investigations should be guided by history and physical examination [ 34 ].…”

“…injuries related to falls) [ 1 , 34 ]. Laboratory investigations should be guided by history and physical examination [ 34 ].…”

Trends in anticholinergic and opioid dispensing in older adults from 2004 to 2015: Results from the Personality and Total Health (PATH) Through Life Study

“…Medication requirements for older adults are complex and must be approached carefully to avoid adverse drug events. Although guidelines caution the use of anticholinergics and opioids among older adults, 2,19,20 dispensing of these medications increased over time in this study population. Studies examining the factors associated with these dispensing trends will help us better understand the prescribing practices and inform implementation efforts for safe pharmaceutical use in this population.…”

“…In summary, prescribing for older adult patients presents with its unique set of challenges. It is because of these challenges and the importance in addressing them, that multiple guidelines 2,19,20 attempt to promote efficient prescribing habits for health-care providers treating older adults.…”