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Detoxification and Withdrawal Management

PI: Brian Rush (Institute of Mental Health Policy Research/CAMH)

Leadership Group: Nikki Bozinoff (CAMH, ON); Keith Ahamad (BCCSU, BC); Annie Talbot (University of Montreal, QC); Samuel Hickcox (Nova Scotia Health Authority, NS); Helen Bouman (Albert Health Services, AB)

Given the extensive population health burden from opioid use disorders and related harms which form a core part of the ‘opioid crisis’, the comprehensive and effective delivery of evidence-based treatment constitutes a key element of the required interventions strategy to address this problem. Treatment interventions for opioid use disorder consist mainly of long-term pharmacotherapy (e.g., opioid agonist treatment [OAT]) as a ‘first-line response’ option. There are, however, other therapeutic interventions which for various reasons (e.g., limited OAT infrastructure, resources or expertise) are offered or practiced in Canada, including ‘detoxification/withdrawal management’ approaches. Some of these, as currently practiced, are built on a highly limited evidence-basis, but also rather diversified practices across Canada, which may include considerable risk for harms (e.g., overdose due to lowered tolerance) to the patient, while for others (e.g., opioid tapering, naltrexone provision) evidence is only slowly emerging. Overall, highly limited evidence-based guidance on these approaches currently prevails, which this project aims to address and improve.

Environmental Scan of Detoxification/Withdrawal Management Practice and Needs Across Canada

Detoxification and/or withdrawal management approaches to opioid use disorders are provided and practiced in a sizeable number of institutions or facilities across Canada; many of these practices occur on the basis of non-existent and/or questionable evidence-base and with considerable risk to acute harm (e.g., accidental overdose death) to patients. At the same time, there appear to be needs for evidence-based guidance or support for opioid detoxification/withdrawal management approaches, as driven either by patient and or system/infrastructure needs or demands (e.g., where patients prefer to be off opioids or environments where capacity or skills for OAT do not exist). The objectives of this project include:

  • Document current regional practices across the country for opioid withdrawal management
  • Conduct a comprehensive scan of evidence needs related to detox/withdrawal management in these programs
  • Develop key indicators for Canadian psychosocial and recovery-based treatment programs
  • Identify best practice/model programs and disseminate throughout Canada
  • Identify the perceived system/environmental factors that are influencing current practice