Treatment Principles

A comprehensive approach, all-of-society approach is needed to control the current substance use epidemic. 

A comprehensive approach would attempt to achieve the following goals: 

Modify the social conditions that contribute to the prevalence and severity of substance use disorders. For example, provision of employment and housing will reduce rates of substance use disorders.

Regulate potentially addicting and harmful substances to discourage use by youth and other vulnerable populations, through taxation, limits on the potency of the products, requiring a prescription to obtain the substance, and other means.

Provide low barrier access to medications that reduce withdrawal symptoms and cravings. Examples are: Opioid Agonist Treatment (which employs medication like methadone, buprenorphine, slow-release oral morphine), Naltrexone and anti-craving medications.

Provide counselling and medications for the psychiatric conditions that contribute to substance use disorders.
Provide evidence-based harm reduction interventions, such as take-home naloxone.

Clinical interventions and public policies should set appropriate limits on access to potentially addicting and harmful substances.

People with an active substance use disorder sometimes engage in harmful and dangerous behaviours to meet their need to experience euphoria, relieve cravings and avoid withdrawal. These behaviours include injecting oral medications and selling prescribed medications in order to purchase illicit drugs. Unsupervised injection can result in serious bacterial infections, while diversion expands drug-related harms. Therefore, steps should be taken to limit diversion and unsupervised injection – for example, dispensing medications under observation.

• Treatment programs should be based on evidence of safety and effectiveness.

Multiple controlled trials, systematic reviews and large observational studies have demonstrated that Opioid Agonist Treatment reduces morbidity, mortality and health care utilization. Therefore treatment and harm reduction programs that use opioid agonist medications should employ proven Opioid Agonist Treatment practices, such as observed dosing with gradual introduction of take-home doses. Similarly, formal psychosocial treatment programs should offer medication-assisted treatment for alcohol use disorder, as anti-craving medications have been shown to improve drinking outcomes and reduce health care utilization.

• Treatment programs should promote recovery.

Counselling, case management and wrap around services are essential for for recovery. Governments and health care institutions should provide sufficient funding to enable treatment programs to provide comprehensive, recovery-oriented care.

• Treatment should be readily accessible in the community and in the general health care system.

Emergency Departments, hospitals, primary care and other health care settings should have the capacity to initiate addiction treatment on site, and to connect the patient to community services as needed. Patients living in rural and remote communities should have access to treatment, through virtual care and other strategies.