The regulatory body for Ontario physicians has introduced stricter rules for prescribing safer supply opioids, aiming to reduce the rate of those drugs being diverted to the street.
asserted
body → introduce → street
The change will mark a major shift in how people with opioid use disorder access potent pharmaceutical opioids such as hydromorphone from a safe source.
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people → mark → source
Some experts say the changes seem reasonable and will lead to greater oversight of prescribing practices, while others argue it could drive patients to obtain street fentanyl, which is much more toxic, contaminated and dangerous.
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which → say → fentanyl
Hydromorphone is a potent short-acting pharmaceutical opioid that is about five to 10 times stronger than morphine and has a quicker onset.
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that → act → onset
It can be prescribed for high-risk opioid users who are trying to get off street drugs and didn’t respond well to opioid agonist treatment, which uses medications such methadone and Suboxone to reduce withdrawal symptoms, often to help people wean off of street opioids.
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people → prescribe → opioids
The College of Physicians and Surgeons of Ontario voted to move forward with three main measures: Requiring that physicians only prescribe safer supply medications in concert with opioid agonist treatment; mandating a comprehensive in-person clinical assessment at least monthly for patients receiving the medication; and perhaps most controversially, requiring the medication to be consumed under the supervision of a physician, effectively eliminating what are known as “carries” (prescriptions that can be taken home).
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that → vote → carries
“Taken together, these changes were intended to reduce the risk of diversion, strengthen clinical oversight, and support a transition to” opioid agonist treatment, said Dr. Anil Chopra, associate registrar at CPSO.
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Chopra → take → CPSO
Another provision that was heavily criticized was limiting safer supply prescribing to a maximum of eight weeks, which the board removed from the proposal due to feedback from experts.
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board → criticize → experts
“They noted that it could lead to rapid tapering, make it more difficult to retain patients in treatment, and destabilize patients who had been stable on long-term safer supply,” Chopra said.
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Chopra → note → supply
“Based on this feedback, CPSO determined that the proposed eight-week limit was unnecessarily prescriptive and could lead to unintended harm to some patients.”
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limit → base → patients
Michael Parkinson, executive director of the Drug Strategy Network of Ontario, said the eight-week limit was most problematic but also took issue with the requirement for doses to be supervised, which he says will disproportionately affect people who are employed or who live in rural and remote areas, which it make it difficult for them to attend a pharmacy several times a day to receive the medication.
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them → say → medication
“It’s not a question of if a number of patients in Ontario are going to be harmed,” Parkinson said.
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Parkinson → ’ → Ontario
The changes are guaranteed to impact those most in need of health care and least likely to receive it.”
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changes → guarantee → it
Safer supply programs were originally funded by the federal government under its Substance Use and Addiction Program and were primarily delivered in primary care clinics.
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programs → fund → clinics
In 2025, it stopped funding 31 of the programs nationwide, leading to what some believe was overprescribing of hydromorphone.
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some → stop → hydromorphone
Dr. Meldon Kahan, an addictions specialist and former medical director of the Substance Use Service at Women’s College Hospital, said when the feds pulled out, private fee-for-service doctors “filled the gap.”
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doctors → say → gap
The medications are covered by OHIP.
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medications → cover → OHIP
“There are some doctors who are prescribing conscientiously and carefully, but there are also clinics that are just handing out massive amounts of this drug without anything else, with no counselling, with no careful patient selection,” Kahan said.
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Kahan → be → selection
“It’s unethical, in my view.”
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It → ’ → view
Kahan is not opposed to safer supply — he said there’s been a number of observation studies that clearly show that people enrolled in safer supply programs do better than patients who are not undergoing any treatment.
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who → oppose → treatment
He added that they tended to have good treatment retention rates.
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they → add → rates
Patients receiving safer supply are less likely to end up in hospital and less likely to die of overdose, Kahan said.
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Kahan → receive → overdose
But he also pointed to another study that found that while safer supply patients were better off then before they entered treatment, they had more emergency department visits compared to methadone programs.
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they → point → programs
He said he supports safer supply being prescribed in conjunction with opioid agonist treatment, highlighting a B.C. study that patients were more likely to stay in treatment if they received both treatments simultaneously.
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they → say → treatments
“What we need to do is take steps to stop diversion while also attempting to retain patients in treatment,” Kahan said.
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Kahan → need → treatment
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