Opioid Agonist Treatment (OAT)

Opioid use disorder is a medical condition, not a failure of willpower, and OAT is the treatment with the strongest evidence behind it. A long-acting opioid medication is prescribed at a steady dose that occupies the same receptors other opioids act on. Withdrawal settles, cravings quiet down, and the hour-to-hour cycle of needing to find the next dose stops driving the day.

The point is stability rather than sedation. At the right dose you are not high — you are able to work, sleep, eat, and attend to everything that substance use had crowded out. Treatment often continues for years, and stopping is a decision made carefully with a prescriber, because the risk of overdose rises sharply when tolerance falls.

In British Columbia, where the unregulated drug supply is dominated by fentanyl and its analogues, OAT is also the single most effective way to reduce the risk of dying from an overdose.

OAT is prescribed by physicians and nurse practitioners. The College of Physicians and Surgeons of BC sets different expectations depending on the medication:

• Buprenorphine/naloxone — additional training is strongly encouraged but not required. Any family physician can prescribe it, and many continue prescribing for stable patients who were started by an addiction specialist.
• Methadone, slow-release oral morphine, extended-release oral morphine and injectable OAT — additional training through the Provincial Opioid Addiction Treatment Support Program is mandatory before prescribing.

Since 19 May 2018, Health Canada no longer requires prescribers to hold a federal exemption to prescribe methadone. That removed one barrier, but provincial and college requirements still apply — the training requirement above is set by the College, not by Ottawa.

The College also treats recognising and managing substance use disorder as a core competency for all of its registrants, not a specialty concern.

Pharmacy dispensing of OAT is governed by the College of Pharmacists of BC. As of 30 March 2026 the rules sit in the OAT Practice Standards (Schedule E.12 of the College bylaws under the Health Professions and Occupations Act), with a separate Practice Guide for each medication issued under Regulatory Statement 26-008 — which replaced the older PPP-66 and PPP-67 policy guides. Pharmacy managers, staff and relief pharmacists, and pharmacy technicians at community pharmacies providing OAT must complete the College’s OAT training program.

People often use “safe supply” and OAT interchangeably. They are different things, and the difference matters for what you can expect at the pharmacy counter.

Prescribed alternatives— British Columbia’s formal name for what is usually called safer supply — is a harm reduction measure, not a treatment for opioid use disorder. It provides regulated, pharmaceutical-grade medication of known strength to people at high risk from the unregulated drug supply, so that what they take is not fentanyl of unknown concentration. BCCSU is explicit that it is not intended to treat substance use disorder; OAT is the treatment, and the two are sometimes used alongside each other.

The program covers three groups of medications:

• Opioids — fentanyl, hydromorphone, morphine, oxycodone
• Benzodiazepines — alprazolam, clonazepam, diazepam, lorazepam and others
• Stimulants — dextroamphetamine, methylphenidate, lisdexamfetamine

We do two things here. We dispense OAT at our Promontory Road pharmacy — daily dispensing and witnessed doses where your prescription calls for them, carries exactly as your prescriber has authorized them, and direct contact with your prescriber when something needs sorting out. And for people who need to start treatment, we provide virtual OAT together with OAT Clinic, so the assessment does not depend on finding a prescriber first.

Virtual does not mean entirely remote. Registration, urine drug testing and the other start-up steps happen in person here, and once you are established, dosing is at the counter. The intake form below is where that starts.

If you are switching pharmacies, you don’t need to arrange anything with your current one. Call us or start a transfer and we will coordinate with your prescriber and the other pharmacy so your dosing is not interrupted.

You will deal with the same pharmacists each time. For treatment that involves coming in most days, that continuity is most of what makes it workable.