Overview of management of disorders of opioid use

Overview of substance use and addictive behaviours explains key principles of care for a person with a disorder of substance use. Establishing a therapeutic relationship that engages the person (and ideally those close to them) is central to the management of substance dependence.

Note: The most important element of treatment for substance use is a therapeutic relationship.

Specialist advice on any aspect of care for people with opioid and other substance dependence is available and contact is encouraged; see Contact details for substance use clinical advisory services for clinicians.

Note: Specialist advice is available by phone on any aspect of the management of substance use; contact is encouraged.

The treatment of disorders of opioid use involves one or more of the following:

Harm reduction in substance use and addictive behaviours is relevant for all patients; see ../Overview-of-substance-use-and-addictive-behaviours/c_AMG_Overview-of-substance-use-and-addictive-behaviours_topic_28.html#c_AMG_Overview-of-substance-use-and-addictive-behaviours_topic_28__table-3187 for a printable patient information sheet. Measures to reduce opioid harms include the use of safer-injecting facilities, needle and syringe programs, screening for bloodborne viruses (including hepatitis B, hepatitis C and HIV), vaccination against hepatitis B, and provision of take-home naloxone to reduce risk of death from opioid overdose. Ensuring the safety of a person with a disorder of substance use or addictive behaviour gives advice on managing behavioural disturbance, assessing fitness to drive, and occupational implications of substance use.

MATOD therapy is the mainstay of managing opioid dependence because it is the most effective treatment; it is much more successful than planned withdrawalPicco, 2020. Evidence of benefit is lacking for psychological interventions as standalone treatments of opioid dependence.

Note: MATOD is the most effective treatment for opioid dependence.

Some patients (eg some using prescription opioids) may not be willing to consider MATOD therapy or it may not be clinically appropriate; consultation with a clinical advisory service is recommended for managing substance use in patients with chronic pain. Long-term tapered weaning (deprescribing) of opioids may be an appropriate choice before considering MATOD therapy, provided the prescriber has sought specialist advice and reviewed the legal considerations for prescribing in substance use.

Long-term care offers all patients an ongoing therapeutic relationship and broad consideration of their physical and mental health needs, including relapse prevention for those who achieve abstinence.

Certain populations may benefit from specific considerations in the management of substance use. Advice specific to management of opioid dependence during pregnancy and management of opioid dependence during breastfeeding is included in this topic.