Managing opioid use disorder in primary care: PEER simplified guideline

Christina Korownyk¹, Danielle Perry², Joey Ton³, Michael R Kolber⁴, Scott Garrison⁵, Betsy Thomas⁶, G Michael Allan⁷, Cheryl Bateman⁸, Raquel de Queiroz⁹, Dorcas Kennedy¹⁰, Wiplove Lamba¹¹, Jazmin Marlinga¹², Tally Mogus¹³, Tony Nickonchuk¹⁴, Eli Orrantia¹⁵, Kim Reich¹⁶, Nick Wong¹⁷, Nicolas Dugré¹⁸, Adrienne J Lindblad¹⁹

Affiliations

¹ Family physician and Associate Professor in the Department of Family Medicine at the University of Alberta in Edmonton. cpoag@ualberta.ca.
² Nurse and Clinical Evidence Expert at the Alberta College of Family Physicians in Edmonton.
³ Pharmacist and Clinical Evidence Expert at the College of Family Physicians of Canada in Mississauga, Ont.
⁴ Family physician and Professor in the Department of Family Medicine at the University of Alberta.
⁵ Family physician and Associate Professor in the Department of Family Medicine at the University of Alberta.
⁶ Pharmacist; Project Manager, Education and Knowledge Translation at the Alberta College of Family Physicians; and Assistant Adjunct Professor in the Department of Family Medicine at the University of Alberta.
⁷ Family physician and Director of Programs and Practice Support at the College of Family Physicians of Canada and Professor in the Department of Family Medicine at the University of Alberta.
⁸ Community support worker in Prince George, BC.
⁹ Family nurse practitioner at the Referred Care Clinic in Whitehorse, YT.
¹⁰ Family physician in Lethbridge, Alta.
¹¹ Psychiatrist and addiction physician at St Michael's Hospital in Toronto, Ont.
¹² Family physician at the CUPS Medical Clinic and the Family Care Clinic and a hospitalist physician at the Peter Lougheed Hospital in Calgary, Alta.
¹³ Family physician with the Boyle McCauley Health Centre and the ARCH program of the Royal Alexandra Hospital in Edmonton and Clinical Lecturer in the Department of Family Medicine at the University of Alberta.
¹⁴ Clinical pharmacist at the Peace River Community Health Centre in Peace River, Alta.
¹⁵ Family physician in Marathon, Ont.
¹⁶ Registered social worker at the Northeast Community Health Centre in Edmonton.
¹⁷ Family physician with the Lifemark Chronic Pain Program in Edmonton.
¹⁸ Pharmacist at the CIUSSS du Nord-de-l'Ile-de-Montréal and Clinical Associate Professor in the Faculty of Pharmacy at the University of Montreal in Quebec.
¹⁹ Pharmacist and Knowledge Translation and Evidence Coordinator at the Alberta College of Family Physicians and Associate Clinical Professor in the Department of Family Medicine at the University of Alberta.

PMID: 31088869
PMCID: PMC6516701

Practice Guideline

Managing opioid use disorder in primary care: PEER simplified guideline

Christina Korownyk et al. Can Fam Physician. 2019 May.

. 2019 May;65(5):321-330.

Authors

Affiliations

¹ Family physician and Associate Professor in the Department of Family Medicine at the University of Alberta in Edmonton. cpoag@ualberta.ca.
² Nurse and Clinical Evidence Expert at the Alberta College of Family Physicians in Edmonton.
³ Pharmacist and Clinical Evidence Expert at the College of Family Physicians of Canada in Mississauga, Ont.
⁴ Family physician and Professor in the Department of Family Medicine at the University of Alberta.
⁵ Family physician and Associate Professor in the Department of Family Medicine at the University of Alberta.
⁶ Pharmacist; Project Manager, Education and Knowledge Translation at the Alberta College of Family Physicians; and Assistant Adjunct Professor in the Department of Family Medicine at the University of Alberta.
⁷ Family physician and Director of Programs and Practice Support at the College of Family Physicians of Canada and Professor in the Department of Family Medicine at the University of Alberta.
⁸ Community support worker in Prince George, BC.
⁹ Family nurse practitioner at the Referred Care Clinic in Whitehorse, YT.
¹⁰ Family physician in Lethbridge, Alta.
¹¹ Psychiatrist and addiction physician at St Michael's Hospital in Toronto, Ont.
¹² Family physician at the CUPS Medical Clinic and the Family Care Clinic and a hospitalist physician at the Peter Lougheed Hospital in Calgary, Alta.
¹³ Family physician with the Boyle McCauley Health Centre and the ARCH program of the Royal Alexandra Hospital in Edmonton and Clinical Lecturer in the Department of Family Medicine at the University of Alberta.
¹⁴ Clinical pharmacist at the Peace River Community Health Centre in Peace River, Alta.
¹⁵ Family physician in Marathon, Ont.
¹⁶ Registered social worker at the Northeast Community Health Centre in Edmonton.
¹⁷ Family physician with the Lifemark Chronic Pain Program in Edmonton.
¹⁸ Pharmacist at the CIUSSS du Nord-de-l'Ile-de-Montréal and Clinical Associate Professor in the Faculty of Pharmacy at the University of Montreal in Quebec.
¹⁹ Pharmacist and Knowledge Translation and Evidence Coordinator at the Alberta College of Family Physicians and Associate Clinical Professor in the Department of Family Medicine at the University of Alberta.

PMID: 31088869
PMCID: PMC6516701

Erratum in

Correction.
[No authors listed] [No authors listed] Can Fam Physician. 2019 Oct;65(10):687. Can Fam Physician. 2019. PMID: 31604731 Free PMC article. No abstract available.
Correction.
[No authors listed] [No authors listed] Can Fam Physician. 2019 Oct;65(10):687. Can Fam Physician. 2019. PMID: 31604732 Free PMC article. English. No abstract available.

Abstract

Objective: To use the best available evidence and principles of shared, informed decision making to develop a clinical practice guideline for a simplified approach to managing opioid use disorder (OUD) in primary care.

Methods: Eleven health care and allied health professionals representing various practice settings, professions, and locations created a list of key questions relevant to the management of OUD in primary care. These questions related to the treatment setting, diagnosis, treatment, and management of comorbidities in OUD. The questions were researched by a team with expertise in evidence evaluation using a series of systematic reviews of randomized controlled trials. The Guideline Committee used the systematic reviews to create recommendations.

Recommendations: Recommendations outline the role of primary care in treating patients with OUD, as well as pharmacologic and psychotherapy treatments and various prescribing practices (eg, urine drug testing and contracts). Specific recommendations could not be made for management of comorbidities in patients with OUD owing to limited evidence.

Conclusion: The recommendations will help simplify the complex management of patients with OUD in primary care. They will aid clinicians and patients in making informed decisions regarding their care.

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References

1. Special Advisory Committee on the Epidemic of Opioid Overdoses. National report: apparent opioid-related deaths in Canada (January 2016 to March 2018). Ottawa, ON: Public Health Agency of Canada; 2018.
1. Gomes T, Khuu W, Martins D, Tadrous M, Mamdani MM, Paterson JM, et al. Contributions of prescribed and non-prescribed opioids to opioid related deaths: population based cohort study in Ontario, Canada. BMJ. 2018;362 k3207. - PMC - PubMed
1. Gomes T, Khuu W, Craiovan D, Martins D, Hunt J, Lee K, et al. Comparing the contribution of prescribed opioids to opioid-related hospitalizations across Canada: a multi-jurisdictional cross-sectional study. Drug Alcohol Depend. 2018;191:86–90. Epub 2018 Jul 31. - PubMed
1. Canadian Institute for Health Information. Pan-Canadian trends in the prescription of opioids, 2012 to 2016. Ottawa, ON: Canadian Institute for Health Information; 2017. Available from: https://secure.cihi.ca/free_products/pan-canadian-trends-opioid-prescrib.... Accessed 2019 Mar 10.
1. Shah A, Hayes CJ, Martin BC, Centers for Disease Control and Prevention Characteristics of initial prescription episodes and likelihood of long-term opioid use—United States, 2006–2015. Morb Mortal Wkly Rep. 2017;66(10):265–9. - PMC - PubMed

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Managing opioid use disorder in primary care: PEER simplified guideline

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Managing opioid use disorder in primary care: PEER simplified guideline

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