Opioid agonist therapy (OAT) in downtown Toronto

How OAT is different from detox

Detox means clearing opioids from your body over several days, sometimes with medication to ease withdrawal. On its own, detox treats the withdrawal, not the opioid use disorder underneath it. When detox ends, cravings often come back. Tolerance also drops quickly, so the risk of overdose is especially high in the days and weeks after detox.

OAT takes a different approach. Instead of clearing opioids out and hoping cravings do not return, it keeps a steady level of medication in your body so cravings and withdrawal stay manageable over the long term. Research links OAT with a lower risk of fatal overdose and with people staying in treatment longer, compared with detox alone or no medication. It is used across Ontario in hospitals, community clinics and family practices.

OAT is not the only part of recovery. Many people also find counselling, peer support or care for other health conditions helpful alongside it.

Who OAT is for

OAT is for adults living with opioid use disorder. That includes people who:

• Use opioids from the unregulated street supply
• Started with prescription opioids and became dependent on them
• Have tried to stop before, including with detox
• Are already on OAT at another clinic and want to move their care

You do not have to stop using before your first visit, and you do not need to have everything figured out. We follow a harm reduction approach, which means you will not be asked to leave the program if you continue to use. The goal is to meet you where you are.

Starting treatment safely

The first weeks are when your dose is being set, so they are when your care team watches most closely. Doses start low and go up slowly, based on how you feel. This careful pace is a safety step, not a sign that anything has gone wrong.

Early follow-up visits are usually more frequent, often weekly, so your physician can adjust your dose and check how you are feeling. As your dose settles and things are going well, visits usually become less frequent.

Tell your doctor or pharmacist right away if you feel very drowsy, confused or unsteady, especially in the first weeks of treatment.

Check-ins and urine drug screening

Regular follow-up visits let your physician check how your dose is working, watch for side effects and adjust your plan. You can raise anything that comes up between visits, including cravings, side effects, or life stress that makes treatment harder.

Urine drug screening is used from time to time as part of monitoring, as it is in other OAT programs. It helps your doctor make safe decisions about your dose and your take-home doses. If you want to change your plan, adjust your dose or, one day, slowly come off treatment, that conversation happens with your physician, at your pace.

If the first option does not work

Finding the right fit can take more than one try, and that is common. Doctors usually start with first-line options, which have the most research behind them. If first-line treatment has not worked for you, for example if withdrawal or cravings did not settle or the side effects were hard to live with, there are second-line options. Your doctor can explain what they involve. A second-line option may come with closer monitoring.

Needing a different option does not mean you did anything wrong. Everyone's body and history with opioids are different. To see the factors you and your doctor weigh together, read Choosing an opioid treatment plan with your doctor.

Your prescription and your pharmacy

You can choose a pharmacy close to home or work. When you book, let our team know which pharmacy you would like to use. Not every pharmacy provides OAT, so it is worth checking with your pharmacy first.

Your medication comes from your pharmacy, not from the clinic. The clinic's part is your medical care: your assessment, your prescription and your follow-up visits.

What OAT costs

Physician visits for OAT are covered by OHIP, so there is no charge to see the doctor if you have a valid Ontario health card. If your coverage has lapsed or you do not have OHIP yet, tell our team when you book.

Medication is billed by the pharmacy, not the clinic. What you pay, if anything, depends on your drug coverage. Coverage may come from:

• The Ontario Drug Benefit (ODB) program, for example if you are 65 or older or receive social assistance
• OHIP+, for eligible people 24 and under who do not have a private plan
• A private plan through work or a family member
• The Trillium Drug Program, for households with high drug costs compared with their income
• Non-Insured Health Benefits (NIHB), for First Nations and Inuit patients

Your pharmacist can tell you what your plan covers. For more detail, read Is addiction treatment covered by OHIP in Ontario?

Staying safe on OAT

• Tell your doctor and pharmacist about every medication you take, including over-the-counter products and supplements.
• If you miss several doses in a row, speak with your pharmacist or doctor before your next dose. Your tolerance can drop quickly, and your dose may need to be lowered for safety.
• Carry a naloxone kit and show the people around you where it is. Naloxone can reverse an opioid overdose for a short time, so always call 911 as well. Kits are free at many Ontario pharmacies.
• The unregulated street supply is unpredictable and can be much stronger than expected. If you do use, try not to use alone.

Already on OAT at another clinic?

Moving your care does not mean starting over. At an assessment visit, a physician reviews your treatment history, your current dose and any take-home doses, then confirms your plan with you. Bringing a summary from your current clinic helps.

Until your first visit with us, keep going with your current clinic and pharmacy so you do not miss doses. Read how transferring your treatment works.