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In response to the opioid crisis, in May 2019 Canada became the first country in the world to approve injectable opioid agonist treatment (iOAT) for opioid use disorder. The Health Canada approval allows for injectable hydromorphone or prescription heroin (known as diacetylmorphine) to be prescribed as iOAT. According to Health Canada, “The new treatment options and investments in new projects are an important part of the Government of Canada’s efforts to expand access to safer alternatives to the contaminated illegal drug supply for people at risk of overdose, to provide Canadians with access to innovative treatment options, and to support provincial and territorial health systems and healthcare professionals in treating Canadians with opioid use disorder.“

In September, the first national guidelines for prescribing iOAT were published by the Canadian Research Initiative in Substance Misuse. Opioid use disorder is usually treated with oral opioid agonist treatment (OAT), such as buprenorphine/naloxone or methadone. But some people may not benefit from these treatments. In the guidelines, iOAT is recommended for “patients who have not benefitted from other treatments and those whose individual situations and needs indicate they may benefit from injectable opioid agonist treatment.” People on iOAT visit a clinic or other supervised environment several times per day to self-inject iOAT medications. The goal of iOAT is to decrease the use of illicit opioids, to reduce the associated harms and help improve stability and day-to-day functioning for people with opioid use disorder.