Canadian Guidelines on Opioid Use Disorder Among Older Adults

Launette M Rieb; Zainab Samaan; Andrea D Furlan; Kiran Rabheru; Sid Feldman; Lillian Hung; George Budd; Douglas Coleman

doi:10.5770/cgj.23.420

Canadian Guidelines on Opioid Use Disorder Among Older Adults

Can Geriatr J. 2020 Mar 30;23(1):123-134. doi: 10.5770/cgj.23.420. eCollection 2020 Mar.

Authors

Launette M Rieb¹, Zainab Samaan², Andrea D Furlan³, Kiran Rabheru⁴, Sid Feldman⁵, Lillian Hung⁶, George Budd⁷, Douglas Coleman⁸

Affiliations

¹ Department of Family Practice, University of British Columbia, Vancouver, BC.
² Department of Psychiatry, McMaster University, Hamilton, ON.
³ Department of Medicine, University of Toronto, Toronto, ON.
⁴ Department of Psychiatry, University of Ottawa, Ottawa, ON.
⁵ Department of Family and Community Medicine, University of Toronto, Toronto, ON.
⁶ Canadian Gerontological Nurses Association, Toronto, ON.
⁷ Clinical Pharmacist, Vancouver, BC.
⁸ Family Physician (in private practice), Comox, BC.

Abstract

Background: In Canada, rates of hospital admission from opioid overdose are higher for older adults (≥ 65) than younger adults, and opioid use disorder (OUD) is a growing concern. In response, Health Canada commissioned the Canadian Coalition of Seniors' Mental Health to create guidelines for the prevention, screening, assessment, and treatment of OUD in older adults.

Methods: A systematic review of English language literature from 2008-2018 regarding OUD in adults was conducted. Previously published guidelines were evaluated using AGREE II, and key guidelines updated using ADAPTE method, by drawing on current literature. Recommendations were created and assessed using the GRADE method.

Results: Thirty-two recommendations were created. Prevention recommendations: it is key to prioritize non-pharmacological and non-opioid strategies to treat acute and chronic noncancer pain. Assessment recommendations: a comprehensive assessment is important to help discern contributions of other medical conditions. Treatment recommendations: buprenorphine is first line for both withdrawal management and maintenance therapy, while methadone, slow-release oral morphine, or naltrexone can be used as alternatives under certain circumstances; non-pharmacological treatments should be offered as an integrated part of care.

Conclusion: These guidelines provide practical and timely clinical recommendations on the prevention, assessment, and treatment of OUD in older adults within the Canadian context.

Keywords: geriatric; guideline; older adult; opioid dependence; opioid use disorder; opioids; substance abuse; substance use disorder; systematic review.