Canadian Guidelines on Opioid Use Disorder Among Older Adults

  • Launette M. Rieb University of British Columbia
  • Zainab Samaan McMaster University
  • Andrea D. Furlan University of Toronto
  • Kiran Rabheru University of Ottawa
  • Sid Feldman University of Toronto
  • Lillian Hung Canadian Gerontological Nurses Association
  • George Budd
  • Douglas Coleman
Keywords: Opioids, Opioid Dependence, Opioid Use Disorder, Substance Use Disorder, Substance Abuse, older adult, geriatric, systematic review, guideline



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.


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.


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.


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

Author Biographies

Launette M. Rieb, University of British Columbia
Department of Family Practice
Zainab Samaan, McMaster University
Department of Psychiatry
Andrea D. Furlan, University of Toronto
Department of Medicine
Kiran Rabheru, University of Ottawa
Department of Psychiatry
Sid Feldman, University of Toronto
Department of Family and Community Medicine
George Budd
Clinical Pharmacist
Douglas Coleman
Family Physician
How to Cite
Rieb, L. M., Samaan, Z., Furlan, A. D., Rabheru, K., Feldman, S., Hung, L., Budd, G., & Coleman, D. (2020). Canadian Guidelines on Opioid Use Disorder Among Older Adults. Canadian Geriatrics Journal, 23(1), 123-134.
Clinical Practice Guidelines/Consensus Statements