Substance use health is one of Canada’s most pressing and historically overlooked public health issues.

Substance use health looks at the full range of how people relate to substances – from someone who never uses, to someone who enjoys a glass of wine with dinner, to someone who uses stimulants recreationally on weekends, to someone managing chronic pain with prescribed opioids, or someone who drinks several cups of coffee to get through the day. Everyone has a place somewhere on that spectrum, and that place can change over the course of a lifetime.

Why does this matter? Because substance use exists on a spectrum, so do people’s needs. Substances can carry both benefits and risks, and health support should not only begin once things have gone wrong. People at every point on the spectrum deserve information, respect, and access to care — not just those in crisis.

Learn more from the Community Addiction Peer Support Association.

Substance use health is not a standalone issue. It is shaped by — and in turn shapes — many of the social and health issues you may already care about.

• Poverty: People in lower-income communities are far more likely to die from an opioid-related overdose than people with higher incomes, a gap that’s held steady for decades, even as overall rates have shifted. 
• Mental health: Roughly 1 in 5 people experience a mental health condition and a substance use concern at the same time. For some groups, that overlap is even higher. 
• Housing: Substance use is one of the most commonly reported health challenges among people experiencing homelessness, and it’s also a factor in many evictions.
• Indigenous communities: Indigenous communities continue to experience disproportionate overdose-related harms, shaped by colonialism, systemic racism, underinvestment, and barriers to culturally safe care. While Indigenous Peoples make up about 1 in 40 people in Canada,  they account for roughly 1 in 10 overdose deaths. Indigenous women face especially steep risks, including far higher rates of both fatal and non-fatal overdose than non-Indigenous women.
• Human rights: BC’s Human Rights Commissioner has described the toxic drug crisis as a human rights issue rooted in systemic discrimination, and has stated that treating people who use drugs as if their health issues are moral failings violates their human rights. 
• Gender: Women often face extra barriers to getting help for substance use, even when their needs are just as serious, or more so, than men’s.
• Climate: Extreme heat is dangerous on its own, but it’s especially dangerous for people who use opioids, since heat can worsen sedation, dehydration, and overdose risk. During the 2021 BC heat dome, both extreme heat deaths and toxic drug deaths spiked at the same time, often affecting the same vulnerable communities.

Since national surveillance began in 2016, more than 55,000 Canadians have died from opioid toxicity. In 2025 alone, there were 5,608 opioid-related deaths — more than 15 lives lost every day across Canada. 

This is the backdrop against which Ontario developed a network of supervised consumption sites as part of its response.

In 2018, there were around 20 supervised consumption sites operating across the province, but as of 2026, nearly all have been forced to close following the Ontario government’s decision to transition funding toward a new network of Homelessness and Addiction Recovery Treatment (HART) Hubs.

Newly created, though not all yet fully operational,”HART Hubs”, are designed to increase access to treatment, primary care, mental health services, and housing but critically do not allow supervised consumption or provide other harm reduction supports such as sterile drug use equipment.

As the province withdraws funding for supervised consumption sites, the impact is already measurable.

• The impact so far:
• Between March 2020 and May 2024, Ontario’s supervised consumption sites recorded more than 1.12 million visits from 178,000 unique clients, facilitated  more than 530,000 service referrals — including to housing, case management, and substance use treatment — and reversed more than 22,000 overdoses.
• Toronto Paramedic Services responded to 160 suspected opioid overdose calls in April 2025. By January 2026, that number had more than doubled to 350, reversing a downward trend that had held since 2023.
• In Ontario, an average of six to seven people die each day from opioid-related overdoses – with additional deaths from stimulants.
• The response: Community organizations are extending hours, building mobile outreach, and partnering with shelters and other community spaces to keep life-saving supports reachable — all within current regulatory rules.

Want the fuller story? The Breach traces how harm reduction in Ontario evolved– from the HIV/AIDS epidemic to today’s policy changes and site closures.

An effective response is often described as a continuum of care with four interconnected parts. Each plays a distinct role, and they work best together. When one part is missing or weakened, the others face greater strain and people are more likely to fall through the gaps.

• Prevention: Education and early support that helps people make informed choices before substance use becomes a crisis — things like youth programming, public awareness, and trauma-informed early intervention.
• Harm reduction: Meeting people where they are, right now. This includes supervised consumption, take-home naloxone, drug checking, and needle exchange, all aimed at keeping people alive and connected to care.
• Treatment: options that meet people on their own timeline, whether that’s counselling, peer support, or residential and outpatient care. This recognizes that recovery looks different for everyone.
• Social supports: the conditions that make health possible in the first place. This includes things like stable housing, enough income to live on, and reliable access to food.

Each of these pieces lowers the barrier to the next. Someone who connects with a harm reduction worker today might be ready for treatment next month — but only if the door stays open. 

This approach is echoed by the Canadian Public Health Association, which describes an effective response as a continuum spanning prevention, harm reduction, treatment, and the social determinants of health.

See how this continuum comes to life through the organizations supported by the Emergency Overdose Prevention Fund (EOPF).