Office-based Methadone Prescribing for Opioid Use Disorder: The Canadian Model

In the context of the US overdose crisis, improving access to medications for opioid use disorder is urgently needed. The Canadian model of methadone treatment, whereby clinicians can prescribe methadone for opioid use disorder in office-based settings and methadone can be dispensed through community pharmacies, offers a compelling model for adoption in the US. Office-based settings in which methadone is prescribed often adopt a rapid-access model, allowing walk-in appointments and same-day initiation of methadone. Prescribing authorization requirements have been relaxed over the past 25 years to improve access to methadone. This paper summarizes the model of office-based methadone prescribing in Canada, highlighting the regulatory structures, prescribing practices, and interprofessional collaborations that enable methadone treatment in office-based settings. Potential implementation strategies for adopting office-based prescribing in the US are discussed.