Manitoba Opioid Agonist Therapy Recommended Practice Manual

About the Manual

CPSM convened a working group of experts in the treatment of opioid use disorder (OUD) in 2019. This working group was tasked with assisting the Prescribing Practices Program to develop a new Recommended Practice Manual for the use of buprenorphine-containing medications in the context of Opioid Agonist Therapy (OAT) in Manitoba.

By 2021 the same working group was tasked with updating the CPSM 2014 publication Manitoba Methadone and Buprenorphine Maintenance Recommended Practice. This publication contained minimal guidance on buprenorphine-containing OAT medications and the methadone guidance was outdated. The resulting combination of these two important projects created this new publication, the Manitoba Opioid Agonist Therapy Recommended Practice Manual, completed in 2023.

CPSM receives frequent requests for guidance on the issues addressed in this manual. The chapters are posted individually under the main sections, as below, for providers to find their topic of interest more easily. Where appropriate, buprenorphine-specific and methadone-specific guidance has been provided separately. However, many OAT care topics are addressed collectively for overarching guidance, with medication-specific recommendations provided throughout chapters as applicable.

This manual is intended to be a dynamic online publication that is hosted on this webpage to permit more regular revision. It will be updated periodically as evidence and best practices in this field evolve over time. The manual is also intended to contribute to quality assurance in OAT practice, promote collaboration among professionals and with patients, and inspire continued growth of the OAT community.

Clinicians are encouraged to adopt and incorporate these recommendations into their OAT practice without delay. Should CPSM registrants have any questions about the interpretation of this guidance, please contact the working group Chair, Dr. Marina Reinecke at 204-774-4344.

CPSM acknowledges this manual is the result of extensive collaboration among regulators, practitioners, and colleagues. Collaborators provided perspectives from a diverse array of clinical disciplines and professions. The manual would not have been possible without their immeasurable support and contribution. We hope healthcare professionals will find this guidance useful in providing comprehensive care to their patients on OAT.


Manitoba Opioid Agonist Therapy Recommended Practice Manual in its entirety (382 pages) HERE or download each chapter individually below. 



0.1 Title, Preface, Content Summary, Appendices, Glossary


OAT Guidance

1.1 Introduction Recommendations for Opioid Use Disorder

1.2 Application, Training, & Regulatory Requirements for OAT

1.3 Initiating OAT Comprehensive Assessment, Diagnosis, Informed Consent & Investigations

1.4 Recommendations for Ongoing Care of Individuals on OAT 

1.5 The Relationship with Pharmacy & Prescriptions for OAT

1.6 Managing Polypharmacy, Benzodiazepines, Alcohol, & Polysubstance Use in OAT

1.7 Recommendations for the Use of Urine Drug Testing in the Management of OUD

1.8 Recommendations for In-Hospital Care of Individuals with OUD

1.9 Recommendations for the Treatment of OUD in Pregnancy

1.10 Managing Acute, Chronic, & Perioperative Pain in OAT

1.11 Prevention, Screening, & Management of HIV & Hepatitis C in Individuals with OUD

1.12 Managing Co-Occurring Psychiatric Disorders in the Context of OUD

1.13 Recommendations for Adolescents & OAT 

1.14 Managing Older Patients & Patients with Disabilities on OAT

1.15 Recommendations for Continuity of Care: Residential Treatment, Traveling, Incarceration & RAAM Clinics

1.16 Discontinuing Treatment: Voluntary & Involuntary Withdrawal from OAT 


Buprenorphine-Specific Guidance 

2.1 Introduction: Pharmacology, Precipitated Withdrawal, & Management of Adverse Effects

2.2 Conventional Buprenorphine/naloxone Induction for OUD

2.3 Buprenorphine/naloxone Take-home (Carry) Dosing Recommendations

2.4 Recommendations for Unwitnessed Induction with Buprenorphine/naloxone

2.5 Recommendations for Buprenorphine/naloxone Micro-Dosing Inductions

2.6 Recommendations for Sublocade® & Considerations for Informed Consent


Methadone-Specific Guidance 

3.1 Introduction: Pharmacology of Methadone & Management of Adverse Effects

3.2 Recommendations for Methadone Induction, Titration, & Stabilization for OUD

3.3 Methadone Take-home (Carry) Dosing Recommendations 


Alternative Treatment Guidance (including SROM)

4.1 Alternative Treatment Approaches to OUD Including SROM (Kadian®)