Meet the physicians stonewalling safe supply: Call to Action
Three years after working to influence federal safe supply policy, several of the same small group of addiction doctors may have manoeuvred the College of Physicians and Surgeons of Ontario to place major new barriers on life-saving prescribed safe supply.
Three years ago, seventeen addiction physicians signed an open letter demanding major barriers to prescribed safe supply access. In a three-part investigative series, Drug Data Decoded reported that in almost every case, the letter signatories failed to mention commercial interests including ownership of opioid agonist clinics, rehab businesses, and urine monitoring companies – each of which could financially benefit from greater barriers imposed on prescribed safe supply.
Physicians are imbued with tremendous public trust in pursuing advocacy. As a result, their financial interests must be kept above-board.
Now, several of the same physicians appear to be influencing the College of Physicians and Surgeons of Ontario (CPSO) to place further barriers on prescribing. A January 2025 briefing note by Addiction Medicine Canada, an advocacy organization led by signatories of the 2023 open letter, called for similar or identical changes to those adopted by the CPSO on October 13. The CPSO regulates all physicians in Ontario.
In response, an open letter is circulating. Everyone is invited to read and sign the letter before November 1 to request the following actions by the CPSO Board:
- Pause implementation and suspend the November 16 compliance deadline.
- Consult meaningfully with affected patients, clinicians, pharmacists, researchers, and other affected stakeholders.
- Publish the consultation record, including conflicts of interest, and communications with the provincial government.
- Disclose the evidence supporting the restrictions and evaluate the May 2026 policy changes before imposing further limitations.
- Restore individualized clinical discretion, including exemptions for patients stable on existing treatment.
Open letter (reprinted from form)
October 26, 2026
RE: CPSO's Failure of Due Process, Transparency, and Evidence-Based Regulation
To the Board of Directors of the College of Physicians and Surgeons of Ontario (CPSO)
CC: Ontario Human Rights Commission
We, the undersigned, call on the CPSO to pause implementation of its October 13, 2026 safer supply prescribing amendments and commit to a fair, transparent, and evidence-based process.
Ontario remains in an ongoing overdose crisis, with people continuing to die from an increasingly toxic and unpredictable unregulated drug supply. Decisions affecting access to health care for people who use drugs carry potentially life-or-death consequences.
This letter is not about whether one supports or opposes safer supply. It is about the integrity and independence of medical regulation, and the principles of meaningful consultation, evidence-based decision-making, and individualized patient care.
1. A rushed decision lacking transparency and meaningful consultation
The CPSO departed from its usual public consultation process. Amendments were published on September 28 and approved just 15 days later, on October 13 with no reasons given for this accelerated timeline.
Consultations disproportionately involved organizations advocating for restrictions, including police and municipalities, while excluding meaningful participation from patients receiving safer supply, prescribing clinicians, pharmacists, and independent researchers.
Despite substantial written opposition from patients, physicians, researchers, and civil society organizations, including a legal submission raising concerns under the Canadian Charter of Rights and Freedoms , the Board proceeded with the vote.
The CPSO also provided inconsistent accounts of whom it consulted and has not published a complete record of submissions informing its decision. Although the College maintains that the amendments were initiated independently of the government, Ontario's Minister of Health publicly endorsed the restrictions before the Board voted.
An independent medical regulator must not only act independently but demonstrate that independence.
2. Restrictions imposed without adequate evidence or clinical discretion
At the October 13 meeting, CPSO leadership inaccurately stated that Ontario was the only jurisdiction continuing to permit take-home safer supply prescriptions. Quebec's medical, nursing, and pharmacy regulators jointly published guidance recognizing unsupervised safer supply doses and individualized clinical judgment. A 2023 survey of Quebec prescribers also documented take-home prescribing.
When Directors requested population-level evidence quantifying diversion-related harms, CPSO staff could not provide it. Fundamental questions about patients unable to tolerate opioid agonist therapy, outcomes in other provinces, and possible exemptions remained unanswered.
Nevertheless, the Board eliminated take-home doses regardless of patients' clinical stability or circumstances. This contradicts principles in the CPSO's own Prescribing Drugs policy, which cautions against arbitrary blanket prescribing rules and inappropriate tapering.
The College already has mechanisms to address inappropriate prescribing and introduced additional safeguards in May 2026, without publicly evaluating their impact.
Instead of addressing specific prescribing concerns, the CPSO has imposed blanket restrictions on all safer supply patients. The College requires evidence-based practice from physicians. It must hold its own decisions to the same standard.
3. A dangerous precedent for all areas of medicine
If a regulator can impose sweeping restrictions without meaningful consultation, adequate evidence, or clinical discretion, the same approach could affect reproductive health care, gender-affirming care, pain management, mental health, or any politically contentious treatment.
No area of health care should be regulated according to political controversy rather than clinical expertise, patient needs, and evidence.
We call on the CPSO Board to:
- Pause implementation and suspend the November 16 compliance deadline.
- Consult meaningfully with affected patients, clinicians, pharmacists, researchers, and other affected stakeholders.
- Publish the consultation record, including conflicts of interest, and communications with the provincial government.
- Disclose the evidence supporting the restrictions and evaluate the May 2026 policy changes before imposing further limitations.
- Restore individualized clinical discretion, including exemptions for patients stable on existing treatment.
The CPSO's mandate is to protect the public. People who use drugs are the public too. Their lives and health deserve the same consideration as everyone else’s, especially in the midst of an ongoing overdose crisis.
The integrity of Ontario's medical regulatory system, and the trust of the patients and physicians who depend on it, are at stake.
