Injectable opioid agonist treatment for opioid use disorder: a national clinical guideline

Fairbairn, Nadia; Ross, Josey; Trew, Michael; Meador, Karine; Turnbull, Jeffrey; Macdonald, Scott; Oviedo‐Joekes, Eugenia; Foll, Bernard Le; Goyer, Marie-Ève; Perreault, Michel; Sutherland, Cindy

doi:10.1503/cmaj.190344

Cited by 72 publications

(84 citation statements)

References 31 publications

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“…Much of the included evidence in this review took place prior to the current opioid epidemic, thereby missing important contextual factors related to treatment need and acceptability for homeless populations. Emerging evidence suggests that injectable heroin and injectable hydromorphone are both acceptable and associated with improved outcomes for people who are treatment-refractory [87]. Furthermore, the prevalence of stigma among health care providers towards people who use substances is well-documented and can result in barriers to healthcare access and poor health outcomes [88].…”

Section: Discussionmentioning

confidence: 99%

The effectiveness of substance use interventions for homeless and vulnerably housed persons: A systematic review of systematic reviews on supervised consumption facilities, managed alcohol programs, and pharmacological agents for opioid use disorder

et al. 2020

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BackgroundSubstance use is disproportionately high among people who are homeless or vulnerably housed. We performed a systematic overview of reviews examining the effects of selected harm reduction and pharmacological interventions on the health and social well-being of people who use substances, with a focus on homeless populations. Methods and findingsWe searched MEDLINE, EMBASE, PsycINFO, Joanna Briggs Institute EBP, Cochrane Database of Systematic Reviews and DARE for systematic reviews from inception to August 2019. We conducted a grey literature search and hand searched reference lists. We selected reviews that synthesized evidence on supervised consumption facilities, managed alcohol programs and pharmacological interventions for opioid use disorders. We abstracted data specific to homeless or vulnerably housed populations. We assessed certainty of the evidence using the GRADE approach.

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Section: Discussionmentioning

confidence: 99%

The effectiveness of substance use interventions for homeless and vulnerably housed persons: A systematic review of systematic reviews on supervised consumption facilities, managed alcohol programs, and pharmacological agents for opioid use disorder

et al. 2020

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“…At the time of collecting data for the present study, Crosstown Clinic remained the first and only iOAT program in North America, delivering treatment to approximately 130 people with opioid use disorder [16,37]. In this setting, clients are prescribed up to three doses per day and self-administer medications under the observation of Registered Nurses [38]. During the present study, Physicians were the primary prescribers of iOAT and participants had access to an interdisciplinary care team of Health Professionals (Social Workers, Psychiatrist, Nurse Practitioner, a Nutritionist).…”

Section: Design Setting and Participantsmentioning

confidence: 99%

Building healthcare provider relationships for patient-centered care: A qualitative study of the experiences of people receiving injectable opioid agonist treatment

Marchand

Foreman

Macdonald

et al. 2020

Subst Abuse Treat Prev Policy

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Background: Injectable opioid agonist treatment (iOAT) was designed as a pragmatic and compassionate approach for people who have not benefitted from medication assisted treatment with oral opioids (e.g., methadone). While, a substantial body of clinical trial evidence has demonstrated the safety and effectiveness of iOAT, considerably less is known about the patient-centered aspects of this treatment and their role in self-reported treatment goals and outcomes. The aim of this study was to explore participants' experiences in iOAT as they broadly relate to the domains of patient-centered care. A secondary goal was to explore how these experiences affected participants' self-reported treatment outcomes.Methods: A qualitative methodology, and constructivist grounded theory approach, was used to guide sampling, data collection and analysis. A total of 30 in-depth interviews were conducted with people receiving iOAT in North America's first clinic. Audio-recordings for each semi-structured interview were transcribed and read repeatedly. The strategy of constant comparison was used through iterative stages of line-by-line, focused and theoretical coding until theoretical saturation was achieved. Results: "Building healthcare provider relationships for patient-centered care in iOAT" was the emergent core concept. Healthcare provider relationships were established through two interrelated processes: 'Opening up' was attributed to the positive environment, and to feeling understood and supported by healthcare providers. 'Being a part of care' emerged as participants felt safe to ask for what was needed and had opportunities to collaborate in treatment decisions. These processes established a foundation in which participants experienced care that was responsive to their individual dose, health and psychosocial needs.

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“…The national clinical guideline on injectable opioid agonist treatment for opioid use disorder recommends that prescribers of SIOAT be well-versed in and provide oral OAT, including methadone. 12 As SIOAT is positioned as part of a treatment continuum that includes oral options from more to less intensive, 20%-30% of people on SIOAT choose to deescalate their treatment to oral-only options in the first year. Few, if any, of the practitioners currently offering HMT prescribe methadone, and HMT is positioned as separate from the treatment system.…”

Section: Problems With Hydromorphone Prescribing As a Response To Thementioning

confidence: 99%

Problems with hydromorphone prescribing as a response to the opioid crisis

Bromley

2020

CMAJ

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Injectable opioid agonist treatment for opioid use disorder: a national clinical guideline

Abstract: Individuals with severe opioid use disorder who inject opioids and have not adequately benefited from oral opioid agonist treatment face substantial risks, including premature death, nonfatal overdose, blood-borne infectious diseases, violence and arrest.

Cited by 72 publications

References 31 publications

The effectiveness of substance use interventions for homeless and vulnerably housed persons: A systematic review of systematic reviews on supervised consumption facilities, managed alcohol programs, and pharmacological agents for opioid use disorder

The effectiveness of substance use interventions for homeless and vulnerably housed persons: A systematic review of systematic reviews on supervised consumption facilities, managed alcohol programs, and pharmacological agents for opioid use disorder

Building healthcare provider relationships for patient-centered care: A qualitative study of the experiences of people receiving injectable opioid agonist treatment

Problems with hydromorphone prescribing as a response to the opioid crisis

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