Research Snapshot: Few withdrawal management services have capacity and ability to treat opioid use disorder

What you need to know

The world is experiencing an opioid overdose crisis. Withdrawal management is one approach to treating opioid use disorder, and programs that offer this approach often use opioid agonist therapy (buprenorphine with or without methadone) as one of their tools to manage symptoms. Researchers sent an online survey to withdrawal management programs across Canada to get a picture of how they are engaging with people with opioid use problems. They found that these programs often lack the knowledge or the skills to provide opioid agonist therapy. Survey responses also show significant differences in how these programs support clients with opioid use disorder. The researchers call for development of standardized clinical guidelines for the treatment of opioid use disorder in Canada.

What is this research about?

Rates of opioid overdoses are increasing around the world. In Canada, death rates have increased due to an increasingly toxic drug supply and a lack of access to key substance use services. This situation was worsened by the stress and isolation associated with COVID-19.

One effective approach to the treatment of opioid use disorder is opioid agonist therapy, which involves buprenorphine with or without methadone, often combined with psychosocial treatment. Other treatments include slow-release oral morphine, injectable hydromorphone or diacetylmorphine, oral naltrexone and withdrawal management programs (also known as detoxification or detox).

Withdrawal management is the first line of treatment for people with opioid use disorder. It is offered in supportive residential or nonresidential programs that help people detoxify and support their symptoms. These programs use a variety of approaches, including long-term and short-term maintenance with medications such as opioid agonists or naltrexone, as well as doses of either opioids or agents such as clonidine, along with other non-narcotic medications tapered over time.

Researchers conducted an environmental scan to get a picture of the services that withdrawal management programs across Canada are providing people with opioid use disorder.

What did the researchers do?

They used an online, self-report questionnaire that they sent to 147 public and private withdrawal management programs across Canada. Data collection took place between July 2019 and March 2020.

Questions asked about the clients they served, the types of services they provided, the impact of the opioid overdose crisis on their organization, how they treated clients with opioid use disorder and/or opioid use, whether they provided or referred clients to opioid agonist therapy, barriers to providing this service and follow-up services they provided.

What did the researchers find?

About 60 per cent of the 147 programs that received the survey link submitted responses. Only one respondent was from a private program, so the researchers decided to focus their analysis on public providers. The current article focused on the opioid-specific responses and categorized them according to opioid-specific admissions, provision of opioid agonist therapy and impact of the opioid overdose crisis.

Opioid-specific admissions

Opioid agonist therapy

Impact of the opioid overdose crisis

Limitations of the research

The researchers mentioned several study limitations. Only six out of 10 programs that received the survey link submitted a response. This means their estimate of the number of programs offering opioid agonist therapy for opioid use disorder may not be accurate.

In addition, since Canada has no comprehensive list of all withdrawal management services, the researchers may have missed some programs that offer treatment for opioid use disorder. Also, the study did not include private programs, so the analysis is missing an important piece of the overall picture of programs treating opioid use disorder.

How can you use this research?

The results of this study add to the evidence base on withdrawal management programs in Canada and can be used to move toward standardizing current practices for the treatment of people with opioid use problems.

About the researchers

Farihah Ali1, Cayley Russell1, Justine Law1, Annie Talbot2,3, Tara Elton-Marshall4,5,6, Nikki Bozinoff7,8, Sameer Imtiaz1, Jürgen Rehm16,910,11,12, Valerie Giang13, Brian Rush1

  1. Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Ontario, Canada
  2. Research Centre, Centre Hospitalier de l’Université de Montréal (CRCHUM) Montréal, Québec, Canada
  3. Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
  4. School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
  5. Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
  6. Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
  7. Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Toronto, Ontario, Canada
  8. Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
  9. Institute of Medical Science (IMS), University of Toronto, Toronto, Ontario, Canada,
  10. Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Dresden, Germany
  11. Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
  12. Department of Psychiatry and Psychotherapy, Center for Interdisciplinary Addiction Research (ZIS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
  13. Vancouver Coastal Health, Vancouver, British Columbia, Canada.

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