Choosing an opioid treatment plan with your doctor

Why There Is More Than One Option

Opioid agonist treatment (OAT) is medical treatment for opioid use disorder. Every OAT medication works on the same receptors in the brain that other opioids affect. Taken as prescribed, each one eases withdrawal and reduces cravings, which gives you room to stabilize your life. Physician visits to talk through your options are covered by OHIP. No option is a quick fix, and none is automatically the right choice for everyone.

Where the options differ is in the practical details: how treatment starts, how often you visit the pharmacy at first, how soon take-home doses may be possible, and how each one fits with your health and your other medications. Doctors usually begin with first-line options, which have the most research behind them. Second-line options are available if first-line treatment has not worked. The sections below walk through each factor. Our opioid agonist therapy page explains each step of treatment.

How Treatment Starts

Some options require you to be in mild to moderate withdrawal before the first dose. Taking the first dose too soon, while other opioids are still active in your body, can trigger sudden, intense withdrawal. Your doctor will tell you how long to wait after you last used and which signs of withdrawal to look for.

Other options do not require withdrawal before the first dose. With these, the dose is raised slowly and carefully over the first weeks, and your doctor and pharmacist watch closely for drowsiness. This slower pace is a safety measure, not a sign that anything has gone wrong. Either way, your doctor explains how to start safely before you take your first dose.

How Often You Visit the Pharmacy at First

Most options start with daily witnessed doses at the pharmacy of your choice, where a pharmacist watches you take each dose. This lets your care team confirm the medication is working, and it gives you regular contact with a pharmacist while your dose is being adjusted. For most people, the daily visit is temporary rather than permanent.

Some options are given as an injection by a health professional, so they are needed less often than a daily dose. If daily pharmacy visits would be hard because of work, school, childcare or travel, tell your doctor. It is part of choosing a plan you can keep up with.

How Soon Take-Home Doses May Be Possible

As you become stable, your doctor may allow take-home doses, also called carries. With some options, carries may be possible sooner; with others, they are built up more gradually, following provincial guidelines that consider how long you have been stable, whether you use other substances, and whether you can store doses safely at home.

No schedule is fixed in advance. Your doctor reviews your progress regularly and adjusts as things change. Wherever you keep take-home doses, keep them locked up and out of reach of children and pets.

Your Health and Other Medications

Your health history matters. Some OAT medications can affect the heart's rhythm, so your doctor may order a heart test called an ECG before or during treatment. Liver problems, breathing problems and other health conditions can also shape which option is safest for you.

Many medications interact with OAT, so tell your doctor about everything you take, including over-the-counter products and supplements. Never mix OAT medication with alcohol, benzodiazepines or other sedatives - together they can slow your breathing to a dangerous level. Common side effects of OAT can include constipation, sweating, nausea and drowsiness; many ease as your body adjusts over the first weeks.

Pregnancy

If you are pregnant, or think you might become pregnant, tell your doctor. OAT is used during pregnancy, and your doctor will plan your treatment with your pregnancy in mind and explain which options are suitable. Do not stop treatment suddenly on your own - sudden withdrawal can be risky during pregnancy.

Your Past Treatment and Your Preferences

What you have tried before is useful information, not a mark against you. Tell your doctor what worked, what didn't, and any side effects you had. Your current opioid use and tolerance also matter, because they affect how treatment starts and what dose you may need.

Your own preferences count too: whether you would rather take a daily dose or have an injection less often, how your daily routine works, and who lives with you at home. If first-line treatment has not worked for you, second-line options may be considered. It is always a conversation, not a decision made without you.

The Factors at a Glance

Questions to Bring to Your Appointment

There is no single right answer - the plan that suits you depends on your situation, and your doctor will talk it through with you at your appointment. These questions can help you get the most from that conversation:

• How would I start, and do I need to be in withdrawal first?
• How often will I need to go to the pharmacy at first?
• When might take-home doses be possible for me?
• How does this option fit with my other medications and health conditions?
• What should I do if I miss a dose?
• What are my options if this one does not work for me?

To book an appointment, call 647-748-1337 or email info@addictionclinictoronto.ca; phones are answered 9 a.m. to 5 p.m., seven days a week. Bring your OHIP card, a list of any medications and substances you currently use, and details of any past treatment for opioid use. If you are in crisis or worried about your safety right now, call ConnexOntario at 1-866-531-2600 or 911 - you do not need to wait for an appointment to get help.