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The PEER Simplified Guideline: Managing Opioid Use Disorder in Primary Care – Released

The Patients Experience Evidence Research (PEER) Team were recently published in the May issue of the Canadian Family Physician for their Simplified Guideline: Managing Opioid Use Disorder in Primary Care.

Click to Download the OUD in Primary Care Pathway & Induction Flow Diagram

PEER consists of a group of practising family physicians and allied health care practitioners with over 30 years in providing patient care in both rural and urban practice settings. They recognize the learning needs of practising family physicians (and their teams) and provide “education by primary care for primary care.”


The objective of the Guideline is to use the best available evidence and principles of shared, informed decision making to develop a clinical practice guideline for a simplified approach to managing OUD in primary care.


Recommendations outline the role of primary care in treating patients with OUD, as well as pharmacologic and psychotherapy treatments and various prescribing practices (e.g. urine drug testing and contracts).

For more Guideline related tools and resources visit the PEER Simplified Guideline webpage.

2 Responses

  1. Can you please help me to understand how to interpret the shaded boxes in the COWS scoring box?
    Thanks so much,

    1. Hello Jennifer,

      The COWS score on the PEER one-page handout is a smaller representation of the full Clinical Opioid Withdrawal Scale which can be found here:

      As you will see, each subjective and objective finding has a scoring system. Once you use it a few times you can generally estimate a patient’s withdrawal severity by thinking in terms of “mild, moderate, severe” and attaching a numeric value to that. For your first few assessments you may want to use the traditional full page COWS and then once you become comfortable seeing patients in withdrawal, the smaller version on the PEER handout will be a quick reminder during your assessment.

      Dr. Jessica Kirkwood discusses this further in her Office-based Induction of Buprenorphine/Naloxone video with the CFPC:

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My name is Smitha Yaltho and I feel privileged to work as a family physician. Why? I believe that being a family physician has been the best job any physician can hope to have. I have personally grown in my own abilities and skill-sets with diverse opportunities in ambulatory practice, acute care and work in Facility Living.  Working in primary care has been exciting and has also afforded me tremendous opportunities for growth while still remaining stimulating in its complexity.  I believe that Family physicians are trusted partners in patient care –  every step of the way. 

Why are you volunteering to serve on this committee?
I currently have an interest in Physician Leadership and  trauma informed care.  I have served as a director with the Board of Directors with the Edmonton North PCN, Edmonton’s largest PCN. Thereafter, I have worked as the Director of Medical Services with CapitalCare (also based in Edmonton) for almost 6 years. It is my express wish that my contribution on the ACFP board of directors will highlight the excellence of family medicine that exists right here and now within the Alberta health care system. 

What about the ACFP’s work do you find most valuable?
Ability to highlight and further support the excellence of primary care right here in Alberta.