Opioid Use Disorder: Screening, Diagnosis, and Management

Main Article Content

Privia Randhawa
Seonaid Nolan

Opioid Use Disorder

Abstract

Over the past decade, the opioid crisis in Canada has been worsening. In 2019, over 3,800 people across Canada died due to an apparent opioid-related cause, which represents a 26% increase from just 3 years prior. Given North America’s ongoing opioid crisis, and the contribution opioid-prescribing practices have had to date, a critical need exists to ensure that health care providers are not only educated about safe opioid prescribing but also are knowledgeable about how to effectively screen for, diagnose, and treat an individual with opioid use disorder.


Résumé
Au cours des dix dernières années, la crise des opioïdes au Canada n’a cessé de s’aggraver. En 2019, plus de 3 800 personnes au Canada sont décédées d’une cause apparemment liée à la consommation d’opioïdes, ce qui représente une augmentation de 26 % par rapport à seulement trois ans auparavant. Étant donné la crise des opioïdes qui sévit actuellement en Amérique du Nord et la contribution des pratiques de prescription d’opioïdes qui ont eu cours jusqu’ici, un besoin critique est à combler pour veiller à ce que les fournisseurs de soins soient non seulement formés sur la prescription sécuritaire des opioïdes, mais aussi bien informés sur le dépistage, le diagnostic et le traitement efficace d’un trouble lié à la consommation d’opioïdes.

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References

1. Special Advisory Committee on the Epidemic of Opioid Overdoses. Opioid-related harms in Canada [Internet]. 2020. Available from: https://health-infobase.canada.ca/substance-related-harms/opioids
2. Centers for Disease Control and Prevention. 2019 Annual surveillance report of drug-related risks and outcomes—United States surveillance special report. Centers for Disease Control and Prevention, US Department of Health and Human Services.
3. Wright ER, Kooreman HE, Greene MS, Chambers RA, Banerjee A, Wilson J. The iatrogenic epidemic of prescription drug abuse: County-level determinants of opioid availability and abuse. Drug Alcohol Depend. 2014;138:209–15. http://dx.doi.org/10.1016/j.drugalcdep.2014.03.002
4. Substance Abuse and Mental Health Services Administration. Key substance use and mental health indicators in the United States: Results from the 2018 National Survey on Drug Use and Health. (HHS Publication No PEP19-5068,
NSDUH Series H-54).
5. International Narcotics Control Board. Availability of narcotic drugs for medical use [Internet]. 2019. Available from: https://www.incb.org/incb/en/ narcotic-drugs/Availability/availability.html
6. Reichl M, Bodiwala GG. Use of analgesia in severe pain in the accident and emergency department. Arch Emerg Med. 1987;4(1):25–31. http://dx.doi.org/10.1136/emj.4.1.25
7. Wilson JE, Pendleton JM. Oligoanalgesia in the emergency department. Am J Emerg Med. 1989;7(6):620–3. http://dx.doi.org/10.1016/0735-6757(89)90286-6
8. Hoffman J, Tavernise S. Vexing question on patient surveys: Did we ease your pain? [Internet]. New York Times. 2016 [cited 2019]. Available from: https:// www.nytimes.com/2016/08/05/health/pain-treatment-hospitals-emergency-rooms-surveys.html?_r=0
9. Fischer B, Keates A, Buhringer G, Reimer J, Rehm J. Non-medical use of prescription opioids and prescription opioid-related harms: Why so markedly higher in North America compared to the rest of the world? Addiction. 2014;109(2):177–81. http://dx.doi.org/10.1111/add.12224
10. Fischer B, Rehm J, Tyndall M. Effective Canadian policy to reduce harms from prescription opioids: Learning from past failures. CMAJ. 2016;188(17–18):1240–4. http://dx.doi.org/10.1503/cmaj.160356
11. Fischer B, Jones W, Rehm J. Trends and changes in prescription opioid analgesic dispensing in Canada 2005–2012: An update with a focus on recent interventions. BMC Health Serv Res. 2014;14:90. http://dx.doi. org/10.1186/1472-6963-14-90
12. British Columbia Centre on Substance Use and B.C. Ministry of Health. A guideline for the clinical management of opioid use disorder. 2017 [cited 2018 Nov 14].
13. Dunn KM, Saunders KW, Rutter CM, et al. Opioid prescriptions for chronic pain and overdose: A cohort study. Ann Intern Med. 2010;152(2):85–92. http://dx.doi.org/10.7326/0003-4819-152-2-201001190-00006
14. Nosyk B, Fischer B, Sun H, et al. High levels of opioid analgesic co-prescription among methadone maintenance treatment clients in British Columbia, Canada: Results from a population-level retrospective cohort study. Am J Addict. 2014;23(3):257–64. http://dx.doi.org/10.1111/j.1521-0391.2014.12091.x
15. Cornish R, Macleod J, Strang J, Vickerman P, Hickman M. Risk of death during and after opiate substitution treatment in primary care: Prospective observational study in UK General Practice Research Database. BMJ (Clinical research ed). 2010;341:c5475. http://dx.doi.org/10.1136/bmj.c5475
16. Marteau D, McDonald R, Patel K. The relative risk of fatal poisoning by methadone or buprenorphine within the wider population of England and Wales. BMJ Open. 2015;5(5):e007629.
17. Special Advisory Committee on the Epidemic of Opioid Overdoses. Opioid-related harms in Canada.
18. Grau LE, Dasgupta N, Grau LE, et al. Illicit use of opioids: Is OxyContin® a “gateway drug”? Am J Addict. 2007;16(3):166–73. http://dx.doi.org/10.1080/10550490701375293
19. Lankenau SE, Teti M, Silva K, Bloom JJ, Harocopos A, Treese M. Initiation into prescription opioid misuse amongst young injection drug users. Int J Drug Policy. 2012;23(1):37–44. http://dx.doi.org/10.1016/j. drugpo.2011.05.014
20. Pollini RA, Banta-Green CJ, Cuevas-Mota J, Metzner M, Teshale E, Garfein RS. Problematic use of prescription-type opioids prior to heroin use among young heroin injectors. Subst Abuse Rehabil. 2011;2:173. http://dx.doi.org/10.2147/SAR.S24800
21. Mars SG, Bourgois P, Karandinos G, Montero F, Ciccarone D. “Every ‘never’ I ever said came true”: Transitions from opioid pills to heroin injecting. Int J Drug Policy. 2014;25(2):257–66. http://dx.doi.org/10.1016/j. drugpo.2013.10.004
22. Cicero TJ, Ellis MS, Surratt HL, Kurtz SP. The changing face of heroin use in the United States: A retrospective analysis of the past 50 years. JAMA Psychiatry. 2014;71(7):821–6. http://dx.doi.org/10.1001/ jamapsychiatry.2014.366
23. Jones CM, Logan J, Gladden RM, Bohm MK. Vital signs: Demographic
and substance use trends among heroin users—United States, 2002–2013. MMWR Morb Mortal Wkly Rep. 2015;64(26):719.
24. Muhuri P, Gfroerer J, Davies C. Associations of nonmedical pain reliever use and initiation of heroin use in the United States. CBHSQ Data Review. Substance Abuse and Mental Health Services Administration; 2013.
25. Jones CM. Heroin use and heroin use risk behaviors among nonmedical users of prescription opioid pain relievers–United States, 2002–2004 and 2008–2010. Drug Alcoh Depend. 2013;132(1–2):95–100. http://dx.doi.org/10.1016/j.drugalcdep.2013.01.007
26. Macy J, Jr. Foundation, University of Illinois at Chicago. College of Urban Planning and Public Affairs. Survey Research Laboratory, Columbia University. National Center on Addiction and Substance Abuse. Missed opportunity: CASA National survey of primary care physicians and patients on substance abuse. National Center on Addiction and Substance Abuse at Columbia University; 2000.
27. Wickersham JA, Azar MM, Cannon CM, Altice FL, Springer SA. Validation of a brief measure of opioid dependence: The rapid opioid dependence screen (RODS). J Correct Health Care. 2015;21(1):12–26. http://dx.doi.org/10.1177/1078345814557513
28. Lindley B, Cox N, Cochran G. Screening tools for detecting problematic opioid use and potential application to community pharmacy practice: A review. Integr Pharm Res Pract. 2019;8:85–96. http://dx.doi.org/10.2147/ IPRP.S185663
29. Bruneau J, Ahamad K, Goyer ME, et al. Management of opioid use disorders: A national clinical practice guideline. CMAJ. 2018;190(9):E247–57. http:// dx.doi.org/10.1503/cmaj.170958
30. Amato L, Davoli M, Minozzi S, Ferroni E, Ali R, Ferri M. Methadone at tapered doses for the management of opioid withdrawal. Cochrane Database Syst Rev. 2013;(2):Cd003409. http://dx.doi.org/10.1002/14651858.CD003409. pub4
31. Fiellin DA, Schottenfeld RS, Cutter CJ, Moore BA, Barry DT, O’Connor PG. Primary care–based buprenorphine taper vs maintenance therapy for prescription opioid dependence: A randomized clinical trial. JAMA Intern Med. 2014;174(12):1947–54. http://dx.doi.org/10.1001/jamainternmed.2014.5302
32. Gowing L, Farrell M, Ali R, White JM. Alpha(2)-adrenergic agonists for the management of opioid withdrawal. Cochrane Database Syst Rev. 2016;(5):Cd002024. http://dx.doi.org/10.1002/14651858.CD002024.pub5
33. Gowing L, Ali R, White JM. Buprenorphine for the management of opioid withdrawal. Cochrane Database Syst Rev. 2009;(3):CD002025. http://dx.doi. org/10.1002/14651858.CD002025.pub4
34. Strang J, McCambridge J, Best D, et al. Loss of tolerance and overdose mortality after inpatient opiate detoxification: Follow up study. BMJ. 2003;326(7396):959–60. http://dx.doi.org/10.1136/bmj.326.7396.959
35. Amato L, Minozzi S, Davoli M, Vecchi S. Psychosocial and pharmacological treatments versus pharmacological treatments for opioid detoxification. Cochrane Database Syst Rev. 2011;(9):Cd005031. http://dx.doi.org/10.1002/14651858.CD005031.pub4
36. Connery HS. Medication-assisted treatment of opioid use disorder: Review of the evidence and future directions. Harv Rev Psychiatr. 2015;23(2):63–75. http://dx.doi.org/10.1097/HRP.0000000000000075
37. Thomas CP, Fullerton CA, Kim M, et al. Medication-assisted treatment with buprenorphine: Assessing the evidence. Psychiatr Serv. 2014;65(2):158–70. http://dx.doi.org/10.1176/appi.ps.201300256
38. Mattick RP, Breen C, Kimber J, Davoli M. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Syst Rev. 2014;(2):Cd002207. http://dx.doi.org/10.1002/14651858. CD002207.pub4
39. Hammig R, Kemter A, Strasser J, et al. Use of microdoses for induction of buprenorphine treatment with overlapping full opioid agonist use: The Bernese method. Subst Abuse Rehabil. 2016;7:99–105. http://dx.doi.org/10.2147/SAR.S109919
40. College Pharmacists of Manitoba. Opioid agonist therapy guidelines for manitoba pharmacists. 2019.
41. Du Collège des Médecins du Québec et de l’Ordre des Pharmaciens du Québec. La buprénorphine dans le traitement de la dépendance aux opioïdes. 2009.
42. Centre for Addiction and Mental Health. Buprenorphine/nalaxone for opioid sependence: Clinical practice guideline. 2012.
43. Mattick RP, Breen C, Kimber J, Davoli M. Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence. Cochrane Database Syst Rev. 2009;(3):Cd002209. http://dx.doi.org/10.1002/14651858. CD002209.pub2
44. Amato L, Davoli M, Perucci CA, Ferri M, Faggiano F, Mattick RP. An overview of systematic reviews of the effectiveness of opiate maintenance therapies: Available evidence to inform clinical practice and research. J Subst Abuse Treat. 2005;28(4):321–9. http://dx.doi.org/10.1016/j.jsat.2005.02.007
45. Sordo L, Barrio G, Bravo MJ, et al. Mortality risk during and after opioid substitution treatment: Systematic review and meta-analysis of cohort studies. BMJ. 2017;357:j1550. http://dx.doi.org/10.1136/bmj.j1550
46. Ahamad K, Hayashi K, Nguyen P, et al. Effect of low-threshold methadone maintenance therapy for people who inject drugs on HIV incidence in Vancouver, BC, Canada: An observational cohort study. Lancet HIV. 2015;2(10):e445–50. http://dx.doi.org/10.1016/S2352-3018(15)00129-0
47. Program SM. Methadone guidelines and standards for the treatment of opioid addiction/dependence. 2015.
48. Socias ME, Wood E, Kerr T, et al. Trends in engagement in the cascade of care for opioid use disorder, Vancouver, Canada, 2006–2016. Drug Alcohol Depend. 2018;189:90–5. http://dx.doi.org/10.1016/j.drugalcdep.2018.04.026 49. College of Physicians and Surgeons of Alberta. Alberta methadone maintenance treatment standards and guidelines for dependence. 2014.
50. College of Physicians and Surgeons of Saskatchewan. Methadone guidelines and standards for the treatment of opioid addiction/dependence. 2015.
51. College of Physicians and Surgeons of Ontario. Methadone maintenance treatment program standards and clinical guidelines. 2011.
52. Newfoundlans and Labrador Pharmacy Board. Standards for the safe and effective provision of medication for the treatment of opioid dependence. 2015. 53. Nova Scotia College of Pharmacists. Standards of practice: Opioid agonist mainenance treatment services. 2017.
54. Ferri M, Minozzi S, Bo A, Amato L. Slow‐release oral morphine as maintenance therapy for opioid dependence. Cochrane Database Syst Rev. 2013;(6):CD009879. http://dx.doi.org/10.1002/14651858.CD009879.pub2
55. Jegu J, Gallini A, Soler P, Montastruc JL, Lapeyre-Mestre M. Slow-release oral morphine for opioid maintenance treatment: A systematic review. Br J Clin Pharmacol. 2011;71(6):832–43. http://dx.doi.org/10.1111/j.1365-2125.2011.03923.x
56. Hämmig R, Köhler W, Bonorden-Kleij K, et al. Safety and tolerability of slow-release oral morphine versus methadone in the treatment of opioid dependence. J Subst Abuse Treat. 2014;47(4):275–81. http://dx.doi.org/10.1016/j.jsat.2014.05.012
57. Canadian Institutes of Health Research. CRISM National Guideline for the Clinical Management of Opioid Use Disorder. 2018.
58. Verthein U, Bonorden‐Kleij K, Degkwitz P, et al. Long‐term effects of heroin‐ assisted treatment in Germany. Addiction. 2008;103(6):960–6. http://dx.doi.org/10.1111/j.1360-0443.2008.02185.x
59. Güttinger F, Gschwend P, Schulte B, Rehm J, Uchtenhagen A. Evaluating
long-term effects of heroin-assisted treatment: The results of a 6-year follow-up. European Addict Res. 2003;9(2):73–9. http://dx.doi.org/10.1159/000068811
60. Oviedo-Joekes E, Brissette S, Marsh DC, et al. Diacetylmorphine versus methadone for the treatment of opioid addiction. N Engl J Med. 2009;361(8):777–86. http://dx.doi.org/10.1056/NEJMoa0810635
61. Fairbairn N, Ross J, Trew M, et al. Injectable opioid agonist treatment for opioid use disorder: A national clinical guideline. CMAJ. 2019;191(38):E1049–56. http://dx.doi.org/10.1503/cmaj.190344
62. Minozzi S, Amato L, Vecchi S, Davoli M, Kirchmayer U, Verster A. Oral naltrexone maintenance treatment for opioid dependence. Cochrane Database Syst Rev. 2011;(4):Cd001333. http://dx.doi.org/10.1002/14651858. CD001333.pub3
63. Sullivan MA, Bisaga A, Mariani JJ, et al. Naltrexone treatment for opioid dependence: Does its effectiveness depend on testing the blockade? Drug Alcohol Depend. 2013;133(1):80–5. http://dx.doi.org/10.1016/j. drugalcdep.2013.05.030
64. Krupitsky E, Nunes EV, Ling W, Illeperuma A, Gastfriend DR, Silverman BL. Injectable extended-release naltrexone for opioid dependence: A double-blind, placebo-controlled, multicentre randomised trial. Lancet. 2011;377(9776):1506–13. http://dx.doi.org/10.1016/S0140-6736(11)60358-9