Supporting physicians in delivering safe, accessible, effective and consistent clinical care to Albertans who may benefit from Opioid Agonist Treatment (OAT).
Opioid Agonist Treatment (OAT), supported by extensive clinical research, has been shown to be more effective than non-pharmacological therapies alone in treating individuals with opioid use disorder (OUD) and reducing the use of illicit opioids.
About Opioid Agonist Treatment (OAT)
Opioid Agonist Treatment (OAT) has been associated with reduced morbidity and mortality and is known to lower the risk of infections such as HIV and hepatitis C among individuals with opioid use disorder.
Commonly used medications for the treatment of opioid use disorder (OUD) include methadone, buprenorphine/naloxone, and slow-release oral morphine (SROM), with additional treatment options continuing to emerge.
The appropriateness of OAT depends on several clinical and contextual factors, including comorbidities, potential drug interactions, the patient’s history and treatment response, prescriber expertise, individual preferences, and the availability of necessary authorizations.
Comprehensive OAT should also incorporate elements such as motivational interviewing, long-term substance use monitoring, provider-led counseling, integrated primary care, and, where appropriate, referrals for psychological treatment and psychosocial support services.
OAT prescribing requirements
Buprenorphine treatment and requirements
Buprenorphine treatment
Buprenorphine is considered a first-line treatment option for opioid use disorder (OUD). It has a distinct pharmacological profile compared to other therapies due to its partial agonist activity, functioning as a mixed agonist-antagonist at opioid receptors.
This mechanism produces a “ceiling effect” at higher doses, reducing the risk of respiratory depression and overdose compared to full opioid agonists such as methadone. Additionally, buprenorphine is effective in suppressing opioid withdrawal symptoms for 24 to 48 hours, supporting its use in both acute and maintenance treatment strategies.
Buprenorphine prescribing requirements
Physicians are not required to obtain prior approval to prescribe buprenorphine for Opioid Agonist Treatment (OAT), nor are they required to complete a TPP Alberta form or register with TPP Alberta when prescribing buprenorphine for the treatment of opioid use disorder (OUD).
Buprenorphine products indicated for the treatment of OUD include:
- Buprenorphine/naloxone (e.g., Suboxone® or generic equivalents)
- Buprenorphine subcutaneous injection (Sublocade®)
- Buprenorphine subdermal implant (Probuphine®)
These medications are classified as Type 2 medication on the TPP Alberta list.
Note: Buprenorphine products indicated for pain management (e.g., Butrans®) are classified as Type 1 medications under the TPP Alberta program and require both a TPP Alberta pad form and prescriber registration with TPP Alberta.
Other treatments and requirements
Other treatments
While physicians are not required to obtain OAT approval to prescribe buprenorphine, additional education and training are required to safely prescribe other Opioid Agonist Treatment (OAT) medications.
These medications include, but are not limited to:
- Methadone
- Slow-Release Oral Morphine (SROM) eg. Kadian
- Injectable Opioid Agonist Therapy (iOAT)
Prescribing requirements
Physicians must meet the following requirements to prescribe certain OAT medications:
- Registration with the Tracked Prescription Program (TPP Alberta) is mandatory for prescribing Type 1 medications.
- An OAT Approval Application must be submitted to obtain prescribing authorization, accompanied by any applicable supporting documentation or evidence of required training.
OAT prescribing approvals
OAT initiation approval
OAT initiation approvals include:
- Successful completion of the Alberta Opioid Dependency Treatment (ODT) Virtual Training program meets the requirements for approval to initiate OAT for OUD. This program is offered through Alberta Health Services. When finished, members will receive a certificate of completion to send directly to CPSA at OAT.info@cpsa.ab.ca if an OAT approval is desired.
- Experiential training in OAT as a treatment for OUD or evidence of appropriate postgraduate training may also qualify.
OAT maintenance approval
OAT maintenance approvals include:
- Completion of three modules of the Alberta ODT Virtual Training Program:
- A letter of support from the patient’s initiating healthcare provider
Approval exceptions
OAT approval exceptions include:
- Regulated members who temporarily prescribe OAT for a patient in an in-patient or correctional facility do not require an OAT approval (initiation or maintenance).
- Prescribers must be in accordance with clause 6 of CPSA’s Safe Prescribing for Opioid Use Disorder standard of practice.
- When providing care in an in-patient or correctional facility setting and initiating OAT, making dose adjustments or introducing medications that may interact with OAT, regulated members are expected to consult with the following as soon as reasonably possible:
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- The appropriate community prescriber
- In-hospital addiction services
- AHS’s Referral, Access, Advice, Placement, Information & Destination (RAAPID) service
- Alberta’s Virtual Opioid Dependency Program (VODP)
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- If patients require urgent or emergent care, regulated members may proceed without consultation. Patients who present for emergency or in-hospital care should have access to OAT when appropriate in the clinical assessment of the attending healthcare provider.
- Approval is not required to prescribe methadone for analgesia (palliative/chronic pain).
- To learn more about methadone for analgesia, please visit Methadone4Pain.ca.
FAQs about OAT
To see more FAQs about OAT, click on All FAQs and filter by "Opioid Agonist Treatment"
All FAQsAm I permitted to prescribe methadone for patients with chronic pain or those receiving palliative care?
The OAT Initiation Approval is specific to the treatment of OUD only.
An approval to provide methadone for analgesia (chronic pain or palliative conditions) is no longer required. You may provide this prescription with TPP Alberta privileges. It is expected that methadone used in these situations will be provided in accordance with current guidelines, recommendations and best practices. If you are looking to refresh or improve your knowledge on methadone for analgesia, please visit Methadone4Pain.ca.
As a primary care physician managing patients with OUD, can I access expert consultation without initiating a formal referral?
You can call the Alberta Health Services (AHS) Referral, Access, Advice, Placement, Information and Destination (RAAPID) call centre to consult with a physician specializing in opioid agonist treatment about your patient’s care.
Expert phone consultations are available from 8 a.m.-5 p.m. daily, including weekends and statutory holidays.
RAAPID North: 1-800-282-9911 for patients north of Red Deer, Alberta
RAAPID South: 1-800-661-1700 for patients in and south of Red Deer
This telephone consultation service is for physicians seeking timely advice regarding prescribing drugs like buprenorphine/naloxone (Suboxone®), methadone or SROM, as well as treating patients with existing OUD.
You can also submit an eReferral advice request, which is a secure and efficient process within Alberta Netcare for physician-to-physician advice.
Send an advice request when you have a non-urgent question where you are seeking guidance with the management of a patient’s OUD or are wondering if a referral is appropriate. The response target is 5 calendar days.
If urgent advice is needed, contact the Virtual Opioid Dependency Program (AHS) by phone at 1-844-383-7688 or by fax at 403-783-7610
How can I locate a clinic in Alberta that provides Opioid Agonist Treatment (OAT)?
CPSA maintains a list of all clinics in Alberta where patients can access Opioid Agonist Treatment (OAT). Please note, appearing on this list does not imply endorsement.
Is OAT approval required to prescribe buprenorphine formulations other than buprenorphine/naloxone for the treatment of opioid use disorder (OUD)?
No. An OAT approval is not required for prescribing buprenorphine for OAT, irrespective of formulation type.
Other formulations of buprenorphine for OAT include Sublocade®, extended-release buprenorphine injection, and Probphine®, subdermal buprenorphine implant.
While an OAT approval is not required, we expect physicians to to complete certification and training recommended by drug manufacturers for these products. Please refer to the respective product monographs for more information.
Buprenorphine OAT formulations are TPP type 2 drugs, and as such, do not require a TPP form or TPP registration to be prescribed.
Where can I find information about other opioid agonist therapies?
You can refer to the CRISM National Guidelines for the Clinical Management of Opioid Use Disorders and BCCSU’s Clinical Resources for Opioid Use Disorders.
For more information, please contact Dr. Monica Wickland-Weller, Senior Medical Advisor at 780-969-4954 or OATinfo@cpsa.ca.
Related Standards of Practice & Advice to the Profession
All ResourcesWe can help. Contact the OAT Program with any questions.
Phone: 780-969-4934
Toll-free: 1-800-561-3899 Ext. 4934 (in Canada)