Opioid Agonist Treatment
Opioid agonist treatment, often called OAT, uses medications such as Suboxone and methadone to treat opioid addiction. The treatment helps reduce drug-related harms and support long-term recovery. BC Mental Health and Substance Use staff are working with government and other partners to increase access to opioid agonist treatment. This is one way we can work toward addressing the challenges of the toxic drug crisis.
What is opioid agonist treatment?
Opioid agonist treatment is a medication-based treatment for people who are dependent on opioid drugs. Examples of opioid drugs are heroin, oxycodone, hydromorphone (Dilaudid), fentanyl and Percocet. OAT is safe and effective.
The treatment helps people who live with opioid addiction:
- Improve their day-to-day functioning
- Find stability
- Manage withdrawal symptoms
- Work toward recovery
Opioid agonist treatment offers other benefits:
- Lowers the risk of transmission of diseases such as hepatitis C and HIV
- Reduces the risk of fatal overdose
- Help people stay in treatment and engage in their care
How does opioid agonist treatment work?
People on opioid agonist treatment take medications such as methadone, buprenorphine/naloxone (Suboxone), or slow-release oral morphine (Kadian). These medications act slowly in the body. They work to prevent withdrawal symptoms and reduce cravings for opioid drugs. Patients or clients will be under a doctor’s care when taking these medications. This is to ensure their safety.
The treatment works best when combined with other types of support, including:
- Counselling
- Long-term substance use monitoring (e.g. regular assessment and urine drug tests)
- Harm reduction practices and education, such as Take Home Naloxone kits
- Referrals to case management, relapse prevention supports and specialist care
- Comprehensive preventive and primary care, such as yearly check-ups, screenings and immunizations
Our approach
We offer opioid agonist treatment to clients and patients at all our sites, including:
- θəqiʔ ɫəwʔənəq leləm’ (Red Fish Healing Centre for Mental Health and Addiction)
- Heartwood Centre for Women
- Forensic Psychiatric Hospital
- Forensic Psychiatric Regional Clinics
- Correctional Health Services, where about 40 per cent of our clients take part in opioid agonist treatment
Suboxone or methadone?
Provincial guidelines recommend buprenorphine/naloxone (Suboxone) as a first-line therapy. This means it is the first medical treatment a health care professional might prescribe for someone living with opioid addiction. It is a partial opioid agonist. It has a lower risk of overdose, fewer and less severe side effects, and a lower risk of drug interactions compared to full opioid agonists such as methadone.
Methadone is still a useful treatment option, especially if buprenorphine/naloxone makes someone feel ill or is ineffective.
Resources for health care professionals
The BC Centre on Substance Use offers a free, online Provincial Opioid Addiction Treatment Support Program. This accredited course is aimed at prescribers, but all health care professionals involved in treating people with opioid use disorders can take this training.
Substance Abuse and Mental Health Services Administration has many resources, programs and data available to help you learn more about prevention, treatment and recovery. Their resource centre contains tool kits, manuals, clinical practice guidelines and other evidence-based resources for communities, clinicians, policy makers and others working in the field.
For patients/clients: Accessing opioid agonist treatment
Your doctor can prescribe opioid agonist treatment. The medications are available through pharmacies or substance use treatment programs. Speak to your doctor about other supports that can help you follow your medication regime.
If you are interested in starting or continuing this course of treatment, contact your doctor or find an opioid agonist treatment clinic (PDF) in your area.
How long does treatment take?
Everyone’s recovery journey is different – it can take a few months or several years. The length of your treatment will depend on how much time you need to deal with the emotional, physical and/or social issues that led to your opioid use in the first place. Generally, treatment for longer than six months is associated with better health outcomes.
What about detox?
Detox alone is not an effective treatment for opioid use disorder. Research (PDF) shows that most people who stop taking opioids without first being stabilized on opioid agonist therapy will lose their tolerance very quickly and relapse. This is very dangerous – if you start using substances at the same dosage you were previously used to, the risk of a fatal overdose is much higher.
Please speak to your doctor if you’re thinking about detox or wanting to skip stabilization. They will help you understand the risks and encourage you to try opioid agonist therapy or a slow taper with methadone or Suboxone. A pharmacist can help set a schedule of dose reductions with frequent follow-up.