This qualitative study examines factors influencing the willingness of family physicians in British Columbia, Canada to prescribe opioid agonist treatment (OAT) via virtual modalities for patients with opioid use disorder (OUD). Although OAT is the first-line treatment for OUD, treatment access, initiation and retention remain low, and improvements in primary care may help. The study included semi-structured interviews with 12 family physicians, which were analyzed thematically using a hybrid inductive-deductive approach. Major findings identified patient (individual characteristics, existing physician relationships, perceived patient stability), physician, and health system (interdisciplinary team, access to centralized patient data systems or support networks) level factors. These factors influence decisions about virtual OAT prescribing. The study highlights the need for policy frameworks to ensure equitable, patient-centered virtual care.