Igor Yakovenko, Yvette Mukaneza, Katuschia Germé, Jacob Belliveau, Ross Fraleigh, Paxton Bach, Ginette Poulin, Peter Selby, Marie-Ève Goyer, Thomas D Brothers, Jürgen Rehm, David C Hodgins, Sherry H Stewart, Evan Wood, Julie Bruneau
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.
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Melissa Richard-Greenblatt, Barbara Stryjewska, Dale R Kalina
{"title":"Réaction lépreuse de type 1 chez un homme de 50 ans.","authors":"Melissa Richard-Greenblatt, Barbara Stryjewska, Dale R Kalina","doi":"10.1503/cmaj.240040-f","DOIUrl":"10.1503/cmaj.240040-f","url":null,"abstract":"","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":"196 38","pages":"E1299-E1300"},"PeriodicalIF":9.4,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11573385/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jeffrey Man Hay Wong, Chelsea Elwood, Deborah Money, Julie van Schalkwyk
{"title":"Listériose durant la grossesse.","authors":"Jeffrey Man Hay Wong, Chelsea Elwood, Deborah Money, Julie van Schalkwyk","doi":"10.1503/cmaj.241056-f","DOIUrl":"10.1503/cmaj.241056-f","url":null,"abstract":"","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":"196 38","pages":"E1297-E1298"},"PeriodicalIF":9.4,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11573381/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Necrotizing soft-tissue infections caused by invasive group A <i>Streptococcus</i>.","authors":"Saswata Deb, Jerome A Leis, Stephanie A Mason","doi":"10.1503/cmaj.240267","DOIUrl":"10.1503/cmaj.240267","url":null,"abstract":"","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":"196 38","pages":"E1291"},"PeriodicalIF":9.4,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11573382/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Refractory annular erythema in a 58-year-old woman.","authors":"Ying Li, Jianna Yan, Yuling Shi","doi":"10.1503/cmaj.241040","DOIUrl":"10.1503/cmaj.241040","url":null,"abstract":"","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":"196 38","pages":"E1292-E1293"},"PeriodicalIF":9.4,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11573380/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A system on the brink.","authors":"Mark Langer","doi":"10.1503/cmaj.241114","DOIUrl":"10.1503/cmaj.241114","url":null,"abstract":"","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":"196 38","pages":"E1295-E1296"},"PeriodicalIF":9.4,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11573379/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Avis de décès pour octobre 2024.","authors":"","doi":"10.1503/cmaj.241436-f","DOIUrl":"10.1503/cmaj.241436-f","url":null,"abstract":"","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":"196 38","pages":"E1304-E1308"},"PeriodicalIF":9.4,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11573387/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Osteoporosis Canada guideline on screening for men likely low value.","authors":"Michelle Greiver, Roland Grad","doi":"10.1503/cmaj.151023-l","DOIUrl":"10.1503/cmaj.151023-l","url":null,"abstract":"","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":"196 38","pages":"E1294"},"PeriodicalIF":9.4,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11573386/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Infection invasive à méningocoque accompagnée de ténosynovite.","authors":"Andriy Katyukha, Sharon Sukhdeo, Nisha Andany, Ariel Lefkowitz","doi":"10.1503/cmaj.240259-f","DOIUrl":"10.1503/cmaj.240259-f","url":null,"abstract":"","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":"196 37","pages":"E1270-E1273"},"PeriodicalIF":9.4,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11537702/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142575087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Diabète de type 2 à début précoce.","authors":"Tharsan Kanagalingam, Catherine Yu, Calvin Ke","doi":"10.1503/cmaj.240398-f","DOIUrl":"10.1503/cmaj.240398-f","url":null,"abstract":"","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":"196 37","pages":"E1274-E1275"},"PeriodicalIF":9.4,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11537701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142575082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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