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. Commonly-used medications for the treatment of OUD include methadone, buprenorphine/naloxone and slow-release oral morphine (SROM), as well as newer forms of medication being introduced.
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 is a first-line treatment option for OUD. It has a unique pharmacological profile relative to other treatment options because of its mixed agonist/antagonist activity as a partial agonist. This creates a “ceiling effect” or plateauing at high doses, which makes an overdose less likely when compared to full agonists like methadone. Buprenorphine can supress withdrawal for 24-48 hours.
Physicians do not require approval to prescribe buprenorphine for OAT and are not required to use a TPP form or register with TPP Alberta to prescribe buprenorphine for the treatment of OUD.
Buprenorphine products with an OUD treatment indication include: buprenorphine/naloxone (e.g. Suboxone® or generic), buprenorphine subcutaneous injection (Sublocade®) and buprenorphine subdermal implant (Probuphine®). Each of these medications is on TPP’s Type 2 drug list
Buprenorphine products for pain, e.g. Butrans®, are TPP Type 1 drugs and require a TPP form to be prescribed. TPP registration is required for prescribing these buprenorphine formulations.
We recommend the following coursesAll Resources
Buprenorphine Treatment for Opioid Use DisorderCentre for Addiction and Mental Health (CAMH) Click to view files
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
Other Opioid Agonist Treatments
While physicians do not require an OAT approval to prescribe buprenorphine, 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
An OAT Approval Application must be submitted to request an OAT approval, along with applicable supporting evidence.
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 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.
- Experiential training in OAT as a treatment for OUD or evidence of appropriate postgraduate training may also qualify.
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
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), but must prescribe 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:
- 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)
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 also 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 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 an OAT approval to prescribe buprenorphine formulations other than buprenorphine/naloxone for opioid use disorder treatment?
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.
How can I find a clinic in Alberta offering 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.
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
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, the BCCSU’s Opioid Use Disorder Guidelines and the Canadian Opioid Use Disorder Guidelines (CAMH).
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
OAT GuidelinesAll 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
OAT Information ChecklistCPSA Click to view files
OAT Letter of Support TemplateCPSA Click to view files
OAT Treatment AgreementClick to view files
Opioid Agonist Treatment ProgramCPSA Click to view files
Opioid Dependency Phone Consultation (AHS)Alberta Health Services (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. 4972 (in Canada)