A commentary in JAMA Health Forum explores the rapid rise and decline of safer supply programs in Canada, highlighting both early benefits for people at risk of overdose and the challenges that threatened long-term sustainability.

Supervised consumption sites (SCS) are evidence-based harm reduction interventions where people can consume drugs under supervision while accessing sterile equipment, and receive emergency overdose response and referrals to care and treatment if needed. Existing peer-reviewed evidence indicates that these sites reduce overdose mortality and risk behaviours associated with infectious diseases, and increase access to substance use treatment and other forms of care.

This brief critical appraisal is intended to support interpretation and outline key limitations of a study published in the journal Addiction on March 10th, 2026 entitled “Healthcare utilization and mortality after overdose prevention site closure: A linked cohort analysis using segmented difference-in-differences time series”.

as part of T-DOT (Toronto Disparities, Overdose and Treatment)

Drawing on survey data from people who use drugs in Toronto, this study finds high levels of police contact and violence, with disproportionate impacts on Indigenous and sexual minority individuals. The findings point to systemic racism within policing practices and emphasize the need for criminal legal reforms that reduce harm and promote equity for marginalized communities.

We conducted an evidence-based analysis of homelessness in Canada to identify strategies that move beyond encampment responses and advance comprehensive, research-informed solutions to the nation’s persistent homelessness crisis.

as part of Safer Opioid Supply Programs Evaluation in Toronto, Ontario

We analyzed data from a pre-post observational cohort of clients enrolled in a SOS program between July 2021 and October 2023. Participants in a SOS program experienced significant reductions in non-fatal overdose during the 6 months following program initiation.

as part of Safer Opioid Supply Programs Evaluation in Toronto, Ontario

This study highlights the need to better define and standardize the parameters of safer supply approaches, including population, dosing, and intended objectives, to enable a more precise assessment of their potential benefits and risks.

as part of Safer Opioid Supply Programs Evaluation in Toronto, Ontario

In this study, we examined barriers and facilitators that influenced the implementation of integrated safer supply pilot programs (ISSPP) across Canada.

as part of Safer Opioid Supply Programs Evaluation in Toronto, Ontario

We conducted a systematic review of qualitative studies on safer opioid supply client experiences published between January 2016 and August 2024.

as part of Piloting and Evaluating Drug Checking Services in Toronto, Ontario

This article outlines the need for evidence-based reforms in Toronto’s drug supply approach in the context of fluctuations in potency and increasing lethality of the city’s unregulated opioid market, particularly regarding carfentanil.