Medication-Assisted Treatment in Canada

What Is Medication-Assisted Treatment?

Medication-assisted treatment (MAT) refers to the use of prescription medications, in combination with counselling and psychosocial support, to treat substance use disorders. In Canadian clinical practice, MAT is now the gold standard for opioid use disorder and has strong evidence for alcohol use disorder as well.

MAT is not "trading one drug for another." The medications used in MAT are prescribed, carefully dosed, taken orally or sublingually, and targeted at specific biological mechanisms of addiction. Peer-reviewed Canadian and international research consistently shows that MAT reduces illicit drug use, reduces overdose death, improves retention in treatment, and improves overall functioning.

MAT for Opioid Use Disorder

Two medications are most commonly used in Canada for opioid use disorder: buprenorphine/naloxone (brand name Suboxone) and methadone. Both are forms of opioid agonist therapy (OAT) — they activate the same receptors as heroin, fentanyl, or prescription opioids, but in a stable, long-acting, controlled way that eliminates withdrawal and blunts cravings without causing a euphoric high when taken as prescribed.

Buprenorphine/naloxone is the recommended first-line treatment in Canadian clinical guidelines because of its strong safety profile, lower risk of overdose, and relative ease of prescribing. Methadone is used when buprenorphine is not a good fit, and is particularly effective for people with very heavy opioid use histories.

A third medication, slow-release oral morphine (Kadian), is approved for OAT in some Canadian jurisdictions for people who have not responded to buprenorphine or methadone. Injectable hydromorphone and diacetylmorphine programmes exist in a small number of specialised clinics for the most complex cases.

MAT for Alcohol Use Disorder

Three medications have good evidence for alcohol use disorder in Canadian clinical guidelines: naltrexone (an opioid receptor blocker that reduces the pleasurable effects of drinking and reduces cravings), acamprosate (which helps stabilise brain chemistry and supports abstinence), and disulfiram (which causes an unpleasant physical reaction when alcohol is consumed, and can be useful as a deterrent in motivated patients).

Despite the evidence, these medications are still underused in Canada. Many people who would benefit from naltrexone or acamprosate never hear about them from their family doctor. It is entirely appropriate — and often life-changing — to ask your physician directly about pharmacotherapy for alcohol use disorder.

Does MAT Mean Lifelong Medication?

There is no predetermined length of time for MAT. For some people, especially those with long and severe opioid use histories, long-term or indefinite OAT is the safest and most effective option, much as long-term medication is standard for other chronic conditions. For others, MAT is used for a defined period of stabilisation and then tapered under clinical supervision.

The decision to continue, taper, or stop should always be made together with a clinician, based on how the person is doing, not on external pressure. Stopping OAT abruptly is strongly associated with return to use and overdose death in people with opioid use disorder — this is a decision to approach carefully.

How to Access MAT in Canada

Access has improved significantly over the past decade. For opioid use disorder, many family physicians, nurse practitioners, and walk-in clinicians in Canada can now prescribe buprenorphine/naloxone directly. Rapid-access addiction medicine (RAAM) clinics exist in many provinces and can often start OAT on a same-day walk-in basis, with no referral required.

Methadone prescribing typically requires a prescriber with additional training, and dosing is usually observed at a pharmacy. Injectable opioid agonist therapy is available through specialised clinics. Your provincial health line or regional addiction service can point you to the closest option.

For alcohol use disorder medications, any family doctor, nurse practitioner, or addiction medicine physician can prescribe naltrexone, acamprosate, or disulfiram. These are typically covered under provincial drug plans for eligible patients.

Combining Medication and Counselling

The evidence is strongest when medication is combined with some form of psychosocial support — individual counselling, group therapy, peer support, or contingency management. That said, people who engage with medication alone still benefit substantially compared to no treatment at all. The guideline is: do not let unavailability of counselling delay starting medication.

Many Canadian programmes structure MAT as part of a broader plan that includes wraparound services such as housing support, mental health treatment, and primary care. These programmes tend to have the best long-term outcomes.

Addressing Stigma

MAT is still sometimes stigmatised in recovery communities, workplaces, and even some treatment centres. Canadian clinical guidelines, the Canadian Research Initiative in Substance Misuse (CRISM), and every major Canadian addiction medicine body are unambiguous that MAT is a legitimate, evidence-based, and often lifesaving form of recovery.

If a treatment programme pressures a patient to stop OAT to enter residential care, that is a signal to look for a different programme. Recovery looks different for different people, and for many Canadians, MAT is what recovery looks like.