Evidence on Opioids

Here you’ll find our best evidence on opioids, divided under the topics of Pain Treatment; Misuse, Overdose, and Harms; Opioid Use Disorder (Addiction); and Alternatives to Opioids. We update our Opioid Evidence Bundle regularly with more evidence, including rapid evidence reviews (Rapid Response reports), Environmental Scans, Horizon Scans, and our larger Optimal Use projects with expert recommendations.

Under our “Tools and Resources,” you’ll find tools you can use to translate research into action as well as information from other organizations, such as, Choosing Wisely Canada and the Canadian Centre on Substance Use and Addiction.

We’ve selected the following materials to get you started:

Utilization of Opioid Agonist Therapies in Canada (Health Technology Review, August 15, 2023)
Cannabis for Opioid Use Disorder (Summary with Critical Appraisal, September 14, 2022)
Diacetylmorphine for Adults With Opioid Dependence (Summary with Critical Appraisal, July 18, 2022)
In Brief: Clinical Effectiveness of Opioid Substitution Treatment (Tool, January 21, 2022)
In Brief: Cost-Effectiveness and Guidelines for Opioid Substitution Treatment (Tool, January 10, 2022)
Clinical Effectiveness of Opioid Substitution Treatment (Summary with Critical Appraisal, January 10, 2022)

In this Bundle

Alternatives to Opioids

Internet-Delivered Cognitive Behavioural Therapy for the Management of Chronic NonCancer Pain: A Summary of a Health Technology Assessment
(Tools, October 19, 2022)
Non-Opioid Options for Managing Pain
To help support decisions about managing pain, we have been reviewing the evidence on different treatment options for various types of pain. Here, you’ll find the highlights of many of these evidence reviews.
Internet-Delivered Cognitive Behavioural Therapy in the Treatment of Chronic Non-Cancer Pain
(Optimal Use, October 3, 2022)
Therapeutic Mattresses for Chronic Pain
(Rapid Review, April 6, 2022)
Capsaicin for Acute or Chronic Non-Cancer Pain: A Review of Clinical Effectiveness, Safety, and Cost-Effectiveness
(Summary with Critical Appraisal, July 13, 2020)
Customized or Prefabricated Shoe Inserts for Chronic, Non-Cancer Pain: A Review of Clinical Effectiveness
(Summary with Critical Appraisal, April 20, 2020)
Body Weight Modification Interventions for Chronic Non-Cancer Pain: A Review of Clinical Effectiveness
(Summary with Critical Appraisal, March 31, 2020)
Manual Therapy for Persistent, Non-Cancer Back and Neck Pain: A Review of Clinical Effectiveness
(Summary with Critical Appraisal, March 2, 2020)
Orthotic Bracing or Splinting of Upper Extremities in Patients with Chronic, Non-Cancer Pain: A Review of Clinical Effectiveness
(Summary with Critical Appraisal, March 2, 2020)
Physical Activity for Chronic Osteoarthritic Knee Pain: A Review of Clinical Effectiveness
(Summary with Critical Appraisal, February 17, 2020)

Misuse/Abuse, Overdose, Harms

Xylazine Test Strips for Drug Checking
(Health Technology Update, July 17, 2023)
Automatic Stop Orders for Opioids
(Rapid Review, March 8, 2023)
Harm Reduction Interventions to Prevent Overdose
(Policy Insight, August 5, 2021)

Opioid Use Disorder/Addiction Treatment

Utilization of Opioid Agonist Therapies in Canada
(Technology Review, August 15, 2023)
Occupational Therapy for Mental Health Conditions and Substance Use Disorders
(Rapid Review, April 27, 2023)
Cannabis for Opioid Use Disorder
(Rapid Review, October 3, 2022)
Diacetylmorphine for Adults With Opioid Dependence
(Rapid Review, July 18, 2022)
Clinical Effectiveness of Opioid Substitution Treatment
Short on time? Read the In Brief.
Cost-Effectiveness and Guidelines for Opioid Substitution Treatment
Short on time? Read the In Brief.
Psychedelic-Assisted Psychotherapy for Post-Traumatic Stress Disorder, Anxiety Disorders, Mood Disorders, or Substance Use Disorders
(Rapid Review, June 25, 2021)
Laxatives and Erectile Dysfunction Medications to Treat Side Effects of Opioid Agonist and Methadone Maintenance Therapy
(Rapid Review, June 22, 2021)
Treatment Programs for Substance Use Disorder
(Summary with Critical Appraisal, June 8, 2021)
Injectable Opioid Agonist Treatment for Patients with Opioid Dependence: A Review of Clinical and Cost-Effectiveness
(Summary with Critical Appraisal, June 2, 2020)
Buprenorphine-Naloxone Tablet Versus Methadone for the Treatment of Patients with Opioid Use Disorder: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines
Short on time? Read the In Brief (Summary with Critical Appraisal, July 2019).
buprenorphine
(Report, July 16, 2019)
Buprenorphine for Opioid Use Disorders during Pregnancy: A Review of Comparative Clinical Effectiveness, Safety, Cost-Effectiveness, and Guidelines
Short on time? Read the In Brief.
Buprenorphine for Opioid Use Disorder: A Review of Comparative Clinical Effectiveness, Safety, Cost-Effectiveness, and Guidelines
Short on time? Read the In Brief.
Buprenorphine hydrochloride
(Report, April 18, 2019)
Buprenorphine Implant for the Treatment of Opioid Use Disorder
(Report, March 21, 2017)

Pain Treatment

Models of Care for Chronic Non-Cancer Pain: A Summary of the Research on Stepped Care and Hub-and-Spoke Models
(Tools, October 14, 2022)
Stepped Care Models for Chronic Pain
(Technology Review, May 30, 2022)
Hub-and-Spoke Models of Care for Chronic Pain
(Technology Review, May 2, 2022)
Medications Containing Low-dose Codeine for the Treatment of Pain and Coughs
(Rapid Review, August 20, 2021)
Codeine for Pain Related to Caesarean Section: A Review of Clinical Effectiveness
(Summary with Critical Appraisal, March 3, 2021)
Codeine for Acute Dental Pain and Acute Pain Related to Dental Procedures
(Summary with Critical Appraisal, March 3, 2021)
Codeine for Pain Related to Osteoarthritis of the Knee and Hip: A Review of Clinical Effectiveness
(Summary with Critical Appraisal, December 14, 2020)
Target-Controlled Infusion with Propofol and Remifentanil for Moderate Procedural Sedation in Medicine and Dentistry: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines
(Summary with Critical Appraisal, November 16, 2020)
Capsaicin for Acute or Chronic Non-Cancer Pain: A Review of Guidelines
(Summary with Critical Appraisal, June 29, 2020)
Pharmacological Interventions for Chronic Pain in Pediatric Patients: A Review of Guidelines
(Summary with Critical Appraisal, May 5, 2020)
Tapentadol Hydrochloride
(Report, December 21, 2018)
Navigating Opioids for Chronic Pain
A visualization of the impact of high dose-prescribing developed by the Institute for Safe Medication Practices Canada, the University of Toronto Faculty of Medicine, and Physicians for Responsible Opioid Prescribing, and endorsed by CADTH and the Canadian Patient Safety Institute.
2017 Canadian Guideline for Opioids for Chronic Pain
Guidelines from the Michael G. DeGroote National Pain Centre at McMaster University and funded by Health Canada and the Canadian Institutes of Health Research

Tools and Resources

In Brief: Clinical Effectiveness of Opioid Substitution Treatment
(RC1405-000 - RB1604-000, January 21, 2022)
In Brief: Cost-Effectiveness and Guidelines for Opioid Substitution Treatment
(RC1401-000, January 10, 2022)
Assessing and Managing Chronic Non-Cancer Pain
(Tools, November 30, 2021)
Codeine for Pain: A Synopsis of the Evidence
A summary of the evidence (based on a number of our reviews) on codeine for pain.
Acute Pain Management: Non-Pharmacological Interventions
Over the last few years, we have been asked to review, the clinical effectiveness evidence and the recommendations from evidence-based guidelines for treating various acute pain conditions with non-pharmacological interventions. Here, you’ll find the evidence highlights related to those evidence reviews.
Non-Drug Ways to Manage Chronic Pain
Resources for people living with chronic pain and resources for clinicians.
Physical Activity for Chronic Pain: A Synopsis of the Evidence
(Tools, July 28, 2020)
If not opioids, then what?
Hospital News Article
Opioids - Canadian Centre on Substance Use and Addiction
2023 Canadian Centre on Substance Use and Addiction
Opioids for pain after surgery: Your questions answered
Tool from ISMP Canada, February 2018
Opioids Wisely - Choosing Wisely Canada
Choosing Wisely Canada