Background: Canada continues to experience an opioid crisis, with 21 people dying daily, including seven in the province of Ontario. Harm reduction services have been instrumental in reducing opioid-related harms and improving health outcomes. Despite reducing opioid-related harms, the Ontario government cited community safety concerns to justify reduced access to harm reduction services through Bill 223, the Safer Streets, Stronger Communities Act, 2024. This legislation took effect on April 1, 2025, and mandated the closure of consumption and treatment sites within 200 metres of schools and childcare centres. The majority of closed sites have been replaced by Homelessness and Addiction Recovery Treatment (HART) hubs that are focused on abstinence-based programming.
Objectives: This study aimed to: 1) compare harm reduction and recovery-oriented approaches and 2) propose evidence-based policy alternatives to address the opioid crisis.
Methods: A narrative literature review and policy analysis based on a logic model framework were conducted, integrating data from peer-reviewed research, government reports, and public health evaluations.
Results: Findings indicate that the reduction of consumption and treatment sites due to Bill 223 will exacerbate Ontario’s opioid crisis, leading to increased overdoses, disease transmission, and strain on the healthcare system. While the implementation of HART hubs will focus on recovery-oriented services, they are insufficient to mitigate the acute risks of this crisis. To combat the opioid epidemic in Ontario, a full continuum of substance use services is required, which includes the scaling up of harm reduction along with recovery-based services.