Opioid Agonist Therapy

(OAT)

Opioid Agonist Therapy (OAT) has a long track record. It has been used to treat opioid use disorder in Canada since 1959. OAT uses prescription medications (opioid agonists) that work on the same receptors in the brain and body as the opioids the patient has been using. 

Opioid agonists reduce pain, keep patients from experiencing withdrawal symptoms, and limit cravings for additional opioids. Some OAT medications also limit the high a patient would otherwise get if they take opioids that aren't prescribed.  This infographic from Island Health in British Columbia is helpful for understanding the benefits of OAT.

River Stone offers three forms of Opioid Agonist Therapy, described below: 

Oral OAT

Traditional, oral OAT is taken once each day, usually in a flavoured drink or as a tablet that dissolves under the tongue. Patients must have their dose witnessed each day by a healthcare worker (usually a pharmacist). This form of OAT is the most common and it works well for the majority of patients with opioid use disorder who are committed to treatment. 

The most common medications used for oral OAT are methadone and buprenorphine/naloxone (brand name Suboxone). 

Many pharmacies are willing to provide this service, so patients are usually able to find a pharmacy near their home for their daily dosing. 


iOAT

iOAT stands for injectable Opioid Agonist Therapy. (We pronounce it "EYE-oat.") It can help people with treatment-resistant opioid use disorder who haven't had success with traditional OAT. 

Patients are each prescribed an individualized, appropriate dose of liquid hydromorphone that can be taken up to three times each day by self-injection the clinic, under the medical supervision of nurses. Because our clinics are only open ten hours each day, patients are also prescribed a long-acting oral OAT dose to keep them from experiencing withdrawal sickness overnight. 

River Stone opened Atlantic Canada's first iOAT in 2020, but iOAT is not a new treatment. It has been available in British Columbia since 2012 and in Europe since the 1980s. Many scientific studies show that it is safe, it works, and it is a cost effective way to treat treatment-resistant opioid use disorder. For some people, iOAT may be a long term solution. For most others, it is a step in their recovery process. Being on iOAT can help provide the stability and social inclusion that are necessary for many people with severe opioid use disorder to get ready for success with oral therapies or tapering toward abstinence. European studies show that three years is the average length of time people spend on iOAT. 

Sublocade

Sublocade is the liquid, injectable form of Suboxone (which is commonly prescribed as oral OAT). Sublocade only needs to be injected every 28-days at a River Stone clinic. The liquid medication turns to a solid gel once it is injected into the belly. The gel then gradually releases the medication at a sustained rate throughout the month. Patients who have been able to use Suboxone successfully and without bothersome side effects may find Sublocade is an attractive alternative.