Ontario’s medical regulator has approved significant changes to how physicians prescribe safer supply medications, introducing stricter requirements aimed at reducing the diversion of prescribed opioids into the illicit drug market.
The College of Physicians and Surgeons of Ontario (CPSO) approved the amendments on October 13 following a board meeting. The new expectations will require stronger clinical oversight of patients receiving safer supply medications and are scheduled to be implemented by November 16, 2026.
Safer supply programs provide pharmaceutical-grade medications to people at high risk of overdose as an alternative to the unpredictable illicit drug supply.
Safer Supply Must Be Combined With Opioid Treatment
Under the new rules, physicians will only be able to prescribe safer supply opioids in conjunction with opioid agonist therapy (OAT).
OAT uses medications such as methadone and Suboxone to treat opioid dependence and reduce the risks associated with illicit opioid use.
The CPSO said the requirement is intended to strengthen clinical oversight while ensuring patients receiving safer supply also have access to treatment aimed at addressing opioid dependence.
The regulator emphasised that the changes do not ban safer supply prescribing.
Instead, the amendments establish additional requirements that doctors must follow when providing these medications.
No Take-Home Doses Under New Rules
Another major change concerns how safer supply medications are taken.
Prescriptions must clearly identify the medication as “safer supply” and include the instruction “no carries,” meaning patients cannot take doses home.
The requirement is designed to support supervised consumption of safer supply medications and reduce the possibility that prescribed drugs will be diverted to other people or sold on the illicit market.
The most commonly prescribed safer supply medication is hydromorphone, a pharmaceutical opioid that has been used in safer supply programs as an alternative to illicit opioids such as fentanyl.
Monthly In-Person Assessments Required
Doctors will also be required to conduct a comprehensive in-person clinical assessment at least once every month for patients receiving safer supply medication.
This represents a significant increase in the frequency of required in-person monitoring.
The CPSO previously introduced changes in May requiring an in-person assessment before safer supply was initiated and follow-up assessments at least every three months for patients receiving the medication on an ongoing basis.
The latest amendments therefore tighten those requirements further.
Regulator Cites Concerns Over Drug Diversion
The CPSO said the new measures were driven in part by concerns that safer supply medications are being diverted into the illicit drug market.
Dr. Nancy Whitmore, the college’s registrar and CEO, said diversion of safer supply medication raised concerns for both patient and public safety.
The regulator said it had received information from health-system partners and consulted physicians with expertise in addiction medicine before approving the changes.
However, there is uncertainty over the scale of diversion.
During discussions leading up to the decision, officials acknowledged that there is not enough data to determine precisely how much hydromorphone found on the streets originates from safer supply prescriptions.
Concerns About Patients Who May Be Affected
The changes have also raised concerns among some health-care professionals and harm-reduction advocates.
During the board's discussion, member Peter Wiesner cited data indicating that more than 87 per cent of safer supply patients are already receiving opioid agonist therapy.
He questioned what the new requirement would mean for the remaining patients for whom OAT may not work or may not be suitable.
There are also concerns about patients who live far from pharmacies or who work during the day.
Because the new rules prevent take-home doses, some patients could face difficulties attending a pharmacy or supervised setting regularly to take their medication.
The concerns could be particularly significant in rural areas where access to pharmacies and health-care services may be limited.
No Eight-Week Prescription Limit
The CPSO had previously considered imposing an eight-week limit on how long physicians could prescribe safer supply medication.
That proposal was ultimately not included in the changes approved by the board.
The regulator will instead focus on the combination of opioid agonist therapy, supervised consumption and monthly in-person assessments.
Changes Take Effect in November
The CPSO said physicians will have until November 16, 2026, to transition to compliance with the new expectations.
The amendments will eventually form part of the college’s new Professional Obligations framework when its redesigned website launches in November.
The regulator said it will continue monitoring the effects of the changes and can make further adjustments if necessary.
The decision comes as Ontario continues to debate how best to respond to the opioid crisis, balancing efforts to reduce overdose deaths and provide treatment with concerns about the diversion of prescription medications.
For patients currently receiving safer supply, the new requirements could mean more frequent contact with health-care providers and the loss of take-home doses.
