Background: Opioid agonist therapy (OAT), typically involving buprenorphine or methadone as pharmacotherapy, is an effective treatment for opioid use disorder (OUD) and is a key response to growing opioid-related harms in Canada. OAT delivery in Canada varies between provinces/territories, including differences in prescribing requirements and primary care involvement. For provinces/territories that aim to improve OAT delivery, knowledge of other jurisdictions’ policies, expected outcomes, and how they have been influenced by political, sociocultural, and health system factors, can inform clinical and policy decision-making.
Objectives: To compare OAT prescribing policies across Canadian provinces/territories and understand how and why they occur.
Methods: We conducted a comparative policy analysis, collecting data from policies, guidelines, reports, education/training materials, and published research articles on provincial health systems and drug policies. To describe and compare OAT across all Canadian provinces, we constructed timelines of OAT policies for each jurisdiction from 2014. Experts in each province (clinicians; policymakers) reviewed these to ensure accuracy and relevance. We classified these policies based on provider involvement; financial, personnel, and educational resources for providers; treatment settings; and costs to patients. We also examined any cross-provincial interactions and resource sharing.
Results: In May 2018, Health Canada removed a federal requirement to obtain an exemption to prescribe methadone, which could increase patients’ access to this treatment. After examining provincial policy changes before and after this decision, we identified patterns in OAT prescribing regulations: western jurisdictions (e.g., British Columbia, Alberta, Saskatchewan) tended towards more restrictive prescribing requirements and oversight than their eastern counterparts (e.g., Quebec, New Brunswick, Nova Scotia). We also observed similar geographical patterns with recommendations for providers to use training/guidelines from either British Columbia (west) or Ontario (east).
Conclusions: Our findings suggest that OUD treatment policies may be influenced by geographical, political, and/or professional networks. What is considered evidence or knowledge for decision-making may be shaped by these factors and local policymaking needs. Patient involvement: By engaging people with lived/living experience and decision-makers, further exploration of these factors and their effect on OUD treatment policies can better inform the development of contextually relevant and appropriate policies to improve OUD care.