In late 2024, Ontario had the most safer supply programs of any province in Canada. Then the provincial government banned new programs and began forcing existing ones to close. By the end of March 2025 they had all shut down, replaced with abstinence-based, highly medicalized models that aren’t appropriate for many people at risk of overdose, especially First Nations Peoples.
The authors of a study published in International Journal of Drug Policy show how this has disproportionately affected First Nations Peoples. They looked at safer opioid supply access among registered First Nations Peoples in Ontario between 2019 and 2023, and found that during that period the number of new program initiations increased nearly fivefold—from 15 individuals to 92. The rate was also higher than that of the general Ontario population.
Safer supply programs provide eligible patients with regulated, pharmaceutical alternatives to street-supply drugs, such as hydromorphone as an alternative to the unregulated fentanyl supply.
Coauthor Ashley Smoke was an early advocate for safer supply.
“We knew people were overdosing and dying when they did not have to,” Smoke told Filter. “What was needed was access to a safe and regulated supply of the substances people were already using, so they were not forced to rely on the poisoned street supply.”
Smoke, from Alderville First Nation, is a member of the Ontario Drug Policy Research Network Lived Experience Advisory Group. They are the cofounder of the Ontario Network of People Who Use Drugs, and wear many other hats in harm reduction and drug policy. In their first experience with safer supply they were referred to a program with a strong Indigenous culture, but struggled to access it because of the distance from where they lived.
Many Indigenous people in rural and remote areas experience the same problem. The study found that in 2023, only six of the 92 individuals who started safer supply lived in First Nations communities. The programs had been concentrated in urban areas. The authors also noted that providers within First Nations communities may be unlikely to prescribe safer supply, due to wariness about overprescribing.
The researchers cite ongoing trauma from the Indian Residential Schools and child welfare system.
During approximately the same time period used for the study, the overdose rate among First Nations Peoples in Ontario tripled. In 2022 the rate of fatal overdose was approximately nine times that of the general Ontario population.
The researchers cite ongoing trauma from the Indian Residential Schools and child welfare system. Between the 1830s and 1990s more than 150,000 Indigenous children across Canada were taken from their homes and sent to government-funded, primarily Christian boarding schools. In 2015 this was formally recognized as cultural genocide.
“Indigenous communities have been disproportionately affected by the toxic drug crisis for many years,” coauthor Katie Pine told Filter. “We continue to see the impacts on individuals, families and entire communities.”
Pine is an opioid strategic planning specialist for the Anishinabek Nation, based in North Bay. She said that while it was clear the crisis was continuing to disproportionately impact First Nations communities across Ontario, not enough is known about their on-the-ground experiences of accessing safer supply. The study showed that among First Nations Peoples there is “growing engagement with this harm reduction approach,” making the province’s current stance even more concerning.
“I don’t think any of the findings were particularly surprising to me,” Pine said. “I had worked with safer supply programs and had firsthand experience supporting people who were accessing those services.”
Pine hopes the paper reaches policymakers, and those in a position to fund these types of programs.
“Before safer supply, I had lost custody of my son,” Smoke said. “My relationship with my partner was broken. I had strained relationships with family members, and so much of my life was organized around trying not to be sick, trying to manage pain, trying to access substances, and trying to survive.”
Safer supply changed all that. Once Smoke no longer had to rely on the unpredictable street supply, the “constant pressure, fear and instability” in their life decreased. They regained custody of their son. They were able to focus on repairing their relationships and building a career. Smoke and their partner now have their own home. Smoke credits safer supply for allowing them to make these changes.
“For Indigenous people, substance use cannot be separated from colonization, residential schools, the Sixties Scoop, child welfare, criminalization, racism, poverty, grief, trauma, displacement, and disconnection from culture, land, family and community,” Smoke said. “If safer supply only focuses on the prescription, it misses the full context of people’s lives.”
Image via Washington State Healthcare Authority