Why Opioid Agonist Treatment?
Supported by a strong body of evidence, Opioid Agonist Treatment (OAT) is more effective than non-pharmacological therapies alone when supporting people in treatment for an opioid use disorder (OUD) and suppressing the use of illicit drugs.
OAT has been linked to reduced illness and death, and lowers the risk of infections such as HIV and hepatitis C amongst people who use drugs. Methadone and buprenorphine/naloxone are the most commonly prescribed OAT.
Whether OAT is an appropriate treatment depends on several factors, such as comorbidities, drug interactions, the patient’s history and response to treatment, prescriber experience, patient or provider preferences and appropriate authorizations. Treatment should also include elements of motivational interviewing, long-term substance use monitoring, provider-led counseling, comprehensive primary care and as appropriate, referrals for psychological treatment and psychosocial supports.
Buprenorphine/Naloxone (Suboxone®) is as effective as methadone for treatment of OUD, but with an improved safety profile. The agonist/antagonist action of Suboxone® creates a “ceiling effect,” which makes it less likely to result in overdose.
Physicians do not require an OAT approval to prescribe buprenorphine/naloxone.
As of July 15, 2019, physicians who wish to prescribe buprenorphine/naloxone for patients with an opioid use disorder in Alberta will NOT be required to register with TPP Alberta.
We recommend the following coursesAll Resources
CFPC Webinar: Office-based Induction of Buprenorphine/naloxone using PEER Guideline (25 mins)Click to view files
CFPC Webinar: PEER Simplified Guideline: Managing OUD in Primary Care (60 mins)Click to view files
Centre for Addiction and Mental Health (CAMH) Buprenorphine-Assisted Opioid Dependence Treatment courseCentre for Addiction and Mental Health (CAMH) Click to view files
Other Opioid Agonist Treatments
While physicians do not require an OAT approval to prescribe buprenorphine/naloxone, specific education and training are required to prescribe other OAT medications safely. This includes (but is not limited to) methadone, Slow-release Oral Morphine (SROM) or Injectable Opioid Agonist Therapy (iOAT).
Requirements for prescribing other OAT medications
OAT initiation approval:
- 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 both the Cummings School of Medicine and Alberta Health Services. When finished, members will receive a certificate of completion to send directly to CPSA at OAT.email@example.com if an OAT approval is desired. There is no need to submit an application or any other evidence.
- Experiential training in OAT as a treatment for OUD or evidence of appropriate postgraduate training may also qualify. For alternate courses, an OAT Approval Application must be submitted, along with applicable supporting evidence.
OAT maintenance approval:
- Completion of two modules of the Alberta ODT Virtual Training Program:
- A letter of support from the patient’s initiating healthcare provider
In-hospital prescribers do not require CPSA approval to maintain patients on other OAT medications. However, any changes to the dose must be done in consultation with the initiating prescriber or their delegate.
FAQs about OAT
To see more FAQs about OAT, click on All FAQs and filter by "Opioid Agonist Treatment"All FAQs
Can I provide a methadone prescription to patients with chronic pain or palliative conditions?
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.
Do I need further experiential training to receive an OAT Initiation Approval?
The Alberta ODT Virtual Training Program provides the required experiential training for an approval. If you would still like to work with a mentor for your own education, CPSA can facilitate this arrangement.
If you have taken the BCCSU-Provincial Opioid Addiction Treatment Support Program or the CAMH-Opioid Dependence Treatment Certificate Program, you will need to arrange for direct training, supervision and mentorship with an experienced, CPSA-approved initiating physician to complete your requirements for an approval.
Please contact us for further information at OATinfo@cpsa.ca.
I am a primary care physician caring for patients with OUD. Is there a way for me to access expert advice without a 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¬Æ), 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
I would like to maintain a patient on OAT (methadone or SROM) for OUD. How do I receive OAT Maintenance Approval?
1. You will receive a letter of support and an information checklist from the initiating prescriber asking you to take over care of the patient and maintain their OAT prescription.
2. CPSA will receive the same letter of support and will provide you with an OAT Maintenance Approval.
3. You will have six months to complete Modules 5 and 8 of the Alberta Virtual ODT Training Program online. Upon completion of the module, you will receive a certificate of completion from the course, which you can forward directly to OAT.firstname.lastname@example.org to fulfil the educational requirement. No other documentation is required.
If you provide maintenance treatment for more than one patient, a letter of support from the initiating prescriber is required for each patient. You will receive notification from CPSA that you have approval for each patient.
Where can I find information on other opioid agonist treatments (e.g. SROM and iOAT)?
For SROM, refer to Slow-Release Oral Morphine for Opioid Use Disorder Treatment in Alberta. You can also refer to the CRISM National Guidelines for the clinical management of 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 ProfessionAll Resources
Additional OAT resourcesAll Resources
Canadian Centre on Substance AbuseClick to view files
Changing How We Talk About Substance UseClick to view files
Get Naloxone (AHS)Alberta Health Services (AHS) Click to view files
Methadone for Pain in Palliative Care Online CourseClick to view files
OAT Information ChecklistCPSA Click to view files
OAT Letter of Support TemplateCPSA Click to view files
OAT Treatment AgreementClick to view files
Opioid Dependency Phone Consultation (AHS)Alberta Health Services (AHS) Click to view files
Opioid Dependency Phone Consultation (AHS)Click to view files
Prescribing Suboxone in the Outpatient SettingClick to view files
Slow-Release Oral Morphine for Opioid Use Disorder Treatment in AlbertaClick to view files
We can help. Contact the OAT Program with any questions.
Toll-free: 1-800-561-3899 Ext. 4935 (in Canada)