Opioid use disorder — MCCQE Part 1 MCQ

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HardSubstance UseOpioid use disorderMCCQE Part 1

A 32-year-old meets criteria for moderate methamphetamine use disorder and wants treatment. He has no acute psychosis, suicidality, intoxication, or withdrawal complication. Which initial plan best reflects current Canadian evidence?

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Correct answer: A — Offer behavioural treatment and harm-reduction support

There is no medication currently approved by Health Canada specifically for methamphetamine use disorder. Initial care should engage the patient in evidence-informed behavioural treatment, such as cognitive-behavioural, motivational, and contingency-management approaches where available, while addressing housing, sleep, nutrition, infectious risk, cardiovascular symptoms, and safer-use practices. Co-occurring depression, psychosis, ADHD, and other substance use require assessment and treatment. Emerging or off-label pharmacotherapies may be considered by experienced clinicians after shared discussion of limited evidence, but none should be presented as an approved universal first-line drug. Detoxification alone does not provide sustained treatment, opioid agonist therapy treats coexisting OUD rather than stimulant use by itself, and abstinence must not be a prerequisite for respectful care or harm reduction.

Reference: Canadian Research Initiative in Substance Matters, ASCME: https://crism.ca/ascme/