Injectable Opioid Agonist Treatment Program (iOAT)

Injectable Opioid Agonist Treatment (iOAT) is a crucial option within the spectrum of treatments for opioid use disorder, providing a viable and effective alternative for those who need it most.

iOAT is an advanced and evidence-informed treatment approach for individuals with opioid use disorder. iOAT is prescribed by medical doctors. Clients administer the prescribed injectable opioids in a controlled and supervised setting. The injectable therapy is accompanied by long-acting oral therapy, based on individual client needs, goals and health history. This treatment approach is particularly effective for individuals with opioid use disorder who require an alternative form of treatment to oral agonist therapy (OAT) such as methadone, Kadian or Suboxone.

iOAT is one option within a variety of treatments for opioid use disorder, and part of a broader, integrated care plan that help people who use street drugs which are extremely toxic and unpredictable.

iOAT programs have shown to lead to better health outcomes, including:

  • Reduced or discontinued use of the toxic illicit opioid supply
  • Lowered risk of overdose
  • Decreased criminal activity
  • Improved social functioning and enhanced quality of life, due to the pathways to social supports
  • Regular connection to healthcare, access to counselling and social services such as housing, mental health supports and primary care
  • Improved mental health, physical health, and overall wellbeing for participants

For the past three years, Toronto Public Health (TPH) has been running an iOAT program for people with opioid use disorder at high risk of overdose. This program aims to help people who use intravenous opioids by offering a prescribed injectable opioid alternative such as hydromorphone or sufentanil. This program builds on our existing services and aims to provide comprehensive care and support to those in need.

Clients of this program come to the TPH clinic for their iOAT doses. No iOAT medications leave the TPH clinic.

Clients of this program are not required to stop taking illicit drugs completely, and they will be provided with information and counselling to make informed decisions about their care plan. Counselors and nurses provide client support and engage with them daily. Clients will also be followed by a prescriber to adjust their medication and build an individualized care plan.

The iOAT program is for people who regularly inject illicit opioids, are at risk of overdose and have not benefited from traditional treatments. Ideal candidates include those looking to reduce street opioid use and who can commit to visiting the clinic, two to four times a day. The clinic currently operates seven days a week, from 10 a.m. to 4 p.m.

Clients of the iOAT program can experience many potential benefits, including:

  • Reduced or discontinued use of toxic illicit opioids.
  • Lowered risk of overdose, and improved mental and physical health.
  • Regular connection to a care team.
  • Referrals to additional resources such as housing workers, mental health supports, and primary care.

Toronto Public Health currently has room for new clients. Referrals to the iOAT program can be made on behalf of a client by a health care provider or by self-referral.

  1. Making a Referral:
    • Complete the Eligibility Assessment form with the client. To request a copy, please send an email to iOATworks@toronto.ca.
    • Fax the completed form, capturing demographic information and drug use history, to The Works iOAT Program Intake at 416-392-0810.
  2. Client Approval Process:
    • After review, Toronto Public Health will inform you of the client’s eligibility and the best time for them to meet with our team.
    • They will meet with a counselor to confirm eligibility, a nurse to obtain basic health information, and a prescriber to discuss the care plan.
  3. Commencement of iOAT:
    • Once approved, clients can start on the program.
    • Most clients can initiate treatment on the same day.

Clients can also self refer by walk in and request an intake assessment during clinic hours, Monday to Friday from 10 a.m. to 3:30 p.m.

For more information or for referrals, please call 416-392-0520 or email iOATworks@toronto.ca.