French National Guidelines for the Appropriate Use of Opioids: Analgesia, Opioid Use Disorder, and Overdose Prevention—Part 2: Prevention and Management of Opioid Use Disorder and Overdose

Opioid use disorder (OUD) and overdoses represent critical challenges linked to the widespread availability of opioid medications. To address these risks, the French National Authority for Health convened a multidisciplinary working group to develop comprehensive guidelines on the prevention and management of OUD and overdoses. These recommendations expand on the second part of the guidelines, which specifically addressed the prevention and management of OUD and overdoses. Grounded in the highest level of international evidence and developed through a rigorous formal consensus process, the guidelines emphasize appropriate opioid prescribing as the cornerstone of prevention. They provide practical recommendations for identifying patients at risk, detecting problematic use early, and initiating opioid agonist treatment when indicated. The role of naloxone as an essential tool to prevent fatal overdoses is highlighted, along with strategies for coordinated and multidisciplinary care across diverse healthcare settings. By integrating prevention, treatment, and harm reduction measures, these guidelines seek to balance legitimate access to opioid analgesics with robust safeguards against opioid use disorder and overdose. Although developed within the French healthcare system, their strong evidence base and underlying clinical principles make them applicable to international practice. Together with the first part on pain management, they constitute one of the most comprehensive and up-to-date sets of recommendations on the safe and effective use of opioid medications. Opioid medicines are important for treating pain, but they also carry risks of opioid use disorder and overdose, which can sometimes be fatal. These risks have increased as opioids have become more widely available. Clear national guidance is needed to help patients and healthcare professionals use these medicines safely. This second part of the French national practice guidelines focuses on the prevention and management of opioid use disorder and overdoses. The recommendations were developed with input from doctors, pharmacists, addiction specialists, patients, and public agencies, and are based on international scientific evidence. The guidelines stress the importance of safe prescribing from the start of treatment and educating patients about benefits and risks. They highlight how to recognize early warning signs of problematic use and recommend substitution treatments, such as buprenorphine or methadone, which reduce cravings and lower the risk of overdose. Another key recommendation is to make naloxone, the emergency medicine that reverses an opioid overdose, widely available to patients, relatives, and first responders. These guidelines also call for coordinated, multidisciplinary care that addresses medical, psychological, and social needs. Together with Part 1 of the guidelines, which focuses on clinical use of opioids for pain, they provide a comprehensive and consistent framework to ensure safe access to opioids while reducing harm.