PRESS RELEASE:

FOR IMMEDIATE RELEASE NOVEMBER 5, 2026

Safer Opioid Supply Prescribing: Hundreds of Healthcare Professionals and Concerned Ontarians Call on the College of Physicians and Surgeons of Ontario (CPSO) to Cease and Consult

More than 700 physicians, other health care professionals and concerned community members and dozens of organizations, are demanding that the CPSO Board of Directors pause the new ‘safer opioid supply’ (SOS) prescribing restrictions passed at their October 13 meeting to allow for adequate consultation.

Prescribers, patients, other health care workers, and concerned community members have expressed concern that the new restrictions will seriously harm patients receiving SOS and conflict with existing CPSO prescribing guidance to which all physicians must adhere.

“Clinical discretion guiding patient health is an essential feature of Ontario’s medical system, not a flaw,” said Dr. Sarah Griffiths, a member of Ontario Substance Use Healthcare Providers (OSUHP). “It is deeply troubling to see the CPSO push through these changes based on anecdotal and inaccurate information as well as information that is at odds with established scientific evidence, expert opinion, and extensive feedback from stakeholders.”

The integrity and independence of medical regulators must not be compromised by the influence, real or perceived, of special interest groups, including political, industry, and corporate interests.

Dr. Mergim Binakaj, also a member of OSUHP, is concerned that patients will be forced into a sub-standard model of care - or no care at all. “I am worried about the medical abandonment of patients, particularly those most in need of health care and least likely to receive it anywhere else. The fact that this is happening during the worst overdose crisis in Ontario’s history is both immoral and unsafe.”

The signatories strongly encourage the CPSO to consider the evidence, trust the expertise and experience of affected health care professionals and patients, and engage in a robust and collaborative process that, at a minimum, meets the CPSO standards for ‘meaningful engagement’. In the interim, we advise the CPSO Board of Directors to immediately suspend the compliance deadline of November 16, and pause the policy changes.

The full letter is below. A one-page evidence brief on the CPSO changes from the Ontario Drug Policy Research Network is located here.

To inquire about media availability, please contact: media@osuhp.ca

October 26, 2026

Open Letter on the 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:

1. Pause implementation and suspend the November 16 compliance deadline.
2. Consult meaningfully with affected patients, clinicians, pharmacists, researchers, and other affected stakeholders.
3. Publish the consultation record, including conflicts of interest, and communications with the provincial government.
4. Disclose the evidence supporting the restrictions and evaluate the May 2026 policy changes before imposing further limitations.
5. 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.

Sincerely,

716 signatories, including 586 Ontario-based individuals and organizations; of whom 116 are Ontario-based physicians