This is a prospective cohort study with recruitment by health-care providers, outreach, and word of mouth in Vancouver and Prince George. Participants included 605 Aboriginal participants who were age 14-30 years, reported illicit drug use in the month prior to enrolment, and provided written informed consent. Variables associated with ever being on MMT were analyzed through X2-testing and multivariate logistic regression, limited to people reporting opioid use (n = 397). Less than half of participants reporting daily injection of opioids had ever been on MMT. In adjusted multivariate logistic regression analyses, older age [odds ratio (OR) 1.17; 95 percent confidence interval (CI) 1.08-1.28)]; female gender (OR 3.76; 95 percent CI 2.00-7.07); hepatitis C antibody positivity (OR 2.76; 95 percent CI 1.53-4.95); and daily opioid injection (OR 2.59; 95 percent CI 1.46-4.61) were positively associated with ever being on MMT. Weekly or more alcohol use (OR 0.43; 95 percent CI 0.21-0.87) was negatively associated with ever being on MMT. MMT access by young Aboriginal people is low. The associations between MMT use and other variables need further study to steer efforts directed at recruitment into MMT. The removal of barriers to MMT and inclusion of young Aboriginal people in the development of treatment programs based on Indigenous values are urgently required to help Aboriginal people who use drugs. (Published Abstract)