America could relax opioid treatment access policies

Canada and the United States (U.S.) face an opioid use disorder and opioid overdose epidemic.

The most effective OUD treatment is opioid agonist therapy (OAT). It means buprenorphine (with and without naloxone) and methadone. Although federal approval for OAT occurred decades ago, in both countries, access to and use of OAT is low. Restrictive policies and complex regulations contribute to limited treatment access.


We did a non-systematic literature scan and reviewed all available policy documents. We studied and compared treatment policies and practice at the federal level in Canada vs. United States. And also at the local level in British Columbia (B.C.) vs. Oregon.

There are differences and similarities between federal and local OAT policies. This applies to access to treatment. In Canada, treatment policy control has shifted from federal to provincial authorities. But in the U.S., federal authorities maintain primary control of treatment regulations. Local OAT health insurance coverage policies differed between B.C. and Oregon. While B.C. had 5 treatment options, Oregon had only 2 OAT options with some limitations.

Relaxation of special federal regulatory policies

The Canadian and U.S. federal OAT policies differ. So do the local OAT access and coverage policies in B.C. and Oregon. And it’s also because of the relaxation of special federal OAT regulatory controls in Canada. Our paper also highlights the complicating contributions and likely policy solutions. For example, the prescription regime and drug control regime within the drug policy sub-domain. Or, the constitutional rights within the broader policy domain.

U.S. policy makers and health officials could consider adopting Canada’s regulatory policy approach to expand treatment access.

Better access mitigates the harms of the ongoing opioid overdose epidemic.

Reference: Priest, K. C., Gorfinkel, L., Klimas, J., Jones, A. A., Fairbairn, N., & McCarty, D. (2019). Comparing Canadian and United States opioid agonist therapy policies. Int J Drug Policy. doi:10.1016/j.drugpo.2019.01.020

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