Canada’s oil sands industry uses large volumes of freshwater to extract bitumen from surface-mined ore. With oil production expected to increase 3-fold over the next decade, process water treatment has become a critical issue for oil sands operators, both in terms of sustaining bitumen recovery and protecting freshwater resources. To identify candidate treatment technologies, a review was conducted on the state-of-the-art of water treatment in the oil industry. Significant developments include (i) chemical modifications to adsorbents and membranes to improve pollutant removal and reduce fouling; (ii) hybridization of adsorbent, membrane, and bioreactor technologies to enhance the biological treatment of toxic feedwaters; (iii) advances in photocatalytic oxidation of organic compounds; and (iv) implementation of large-scale treatment wetlands to treat hydrocarbon-contaminated wastewaters. In adapting treatment technologies to the oil sands, operators will need to consider the fouling potential of bitumen and fine clays, the effect of process water alkalinity on treatment performance, and the biodegradability of toxic organic compounds.