The CPSO’s decision to amend its safer supply prescribing policy by requiring all safer supply doses to be witnessed at a pharmacy, with no take-home carries, raises serious concerns about accessibility, discrimination, and the College’s professional obligations to patients. I contacted the CPSO to express my concerns and was told that “policy is policy,” that these restrictions apply to safer supply participants but not to patients enrolled in pain management programs, and that even switching to an alternative opioid such as Kadian would not necessarily avoid the restrictions if the prescription falls within the safer supply definition. When I raised concerns about the consequences for vulnerable patients, the response I received was, “I don’t mean to sound cold, but policy’s policy,” leaving me with the impression that there was little opportunity for meaningful discussion or recourse. These restrictions risk creating significant barriers for people living in rural and remote communities, areas with limited pharmacy access, and individuals with mobility limitations or mental and physical disabilities who may be unable to travel to a pharmacy multiple times a day. Under Ontario’s Human Rights Code, physicians have a duty to provide health services without discrimination based on protected grounds and to accommodate patients’ needs up to the point of undue hardship, respecting their dignity, autonomy, and privacy. A blanket policy that fails to account for individual circumstances risks limiting access to necessary health services and may disproportionately disadvantage people with disabilities. Although the CPSO states that its decision is intended to reduce the diversion of prescribed opioids into the illicit drug supply, Health Canada acknowledges that safer supply programs are designed to reduce exposure to toxic street drugs and that early research has associated these programs with lower individual overdose risk and reduced use of fentanyl and other street-acquired substances. Research published in JAMA Network Open in 2024 also found that diversion can arise from complex circumstances, including unmet needs and attempts to manage withdrawal and overdose risk, suggesting that individualized prescribing and appropriate social supports deserve consideration alongside safeguards. The evidence does not establish that safer supply medications never contribute to harm or diversion; however, neither does it justify assuming that the same restrictions are appropriate for every patient. Pharmaceutical-grade medications provide a more predictable alternative to an unregulated supply that may contain fentanyl and other toxic substances. By imposing inflexible dispensing requirements without sufficient consideration of patients’ individual needs, geographic circumstances, disabilities, and ability to access pharmacies, the CPSO risks undermining the very harm-reduction goals these programs were created to achieve. I am calling on the CPSO to reconsider this policy, meaningfully consult affected patients and healthcare providers, assess its potential human rights and accessibility impacts, and allow individualized clinical decisions and reasonable accommodations rather than imposing a blanket approach that may increase barriers to care and push vulnerable people back toward the unpredictable illicit drug supply.

I have witnessed the Safer Supply Program, as a transformative experience for several individuals. Since joining the program, they have been able to redirect their life away from substance dependency and towards building a sustainable future. One individual in particular has founded their own sustenance farm in rural Ontario providing a personal haven from past struggles with substances, poverty, and food insecurity. This farm is a testament to resilience and a brighter future. For others, they have been able to put their focus away from the procurement of substances since Safer Suppy to rebuilding connections with family members who may live out of their area, going back to school, or getting gainful employment. However, recent amendments by the College of Physicians and Surgeons of Ontario (CPSO) requiring participants to visit a pharmacy several times a day pose a threat to this progress.

These requirements are not only impractical but impose severe constraints on individuals who are already vulnerable. For those with disabilities, the stipulation of daily pharmacy visits escalates the existing barriers to accessibility. People utilizing the Safer Supply Program need the opportunity to lead enriched lives, free from the chains of frequent pharmacy visits, which with these changes will dominate their daily schedules. This obligation forces them to center life around obtaining their medications rather than pursuing their goals and living meaningful lives.

Statistics have shown that stable support systems foster better recovery outcomes. According to Canada's Public Health Agency, providing flexible healthcare approaches, like extended medication refills, significantly enhances a participant’s ability to integrate successfully into society. These amendments have the inverse effect, potentially uprooting their stability and hindering the positive contributions they make to their communities—like the creation and maintenance of a self-sustaining farm.

There is an urgent need for CPSO to reconsider and amend these policies. An adjustment that allows for weekly, rather than daily, pharmacy visits for stable participants would not only alleviate undue pressure but also afford them the dignity of personal empowerment and socio-economic independence. These structural changes can significantly improve quality of life and reinforce recovery successes.

It’s critical for lawmakers and healthcare providers to understand the unique needs of individuals in the Safer Supply Program and address the inequity these requirements create. By adopting a more flexible, person-centered approach, we can enable participants to build secure, productive lives that contribute positively to society.

Your signature can help enact this crucial change. We urge you to support this petition and call on CPSO to reconsider the recent amendments to the Safer Supply Program to accommodate the needs of those it serves.

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