A controversial change to “safer-supply” opioid prescriptions that would force recipients to take them in front of a pharmacist, rather than on their own schedule at home, has been abruptly paused due to a legal challenge.
The College of Physicians and Surgeons of Ontario (CPSO) announced the pause Friday, days before the changes were to come into effect on Monday.
The medical regulator, which governs prescription policy for doctors, said it was served with a legal challenge Friday that included a motion for an injunction to halt the changes. An injunction is a court order that forces an entity to do something specific ordered by the court. CPSO says it agreed to pause the changes to allow time to respond to the injunction.
“We recognize that physicians may already have been working with patients and other members of their care teams in preparation for November 16,” the release said. “During the pause, physicians should continue to practise in accordance with their professional obligations and exercise clinical judgment based on the individual circumstances and needs of their patients.”
CPSO did not respond to a request for more information ahead of publication.
The CPSO announced Oct. 13 that its board had voted for the proposed changes. In addition to eliminating take-home doses of opioids, the changes would require physicians to assess patients receiving the drugs at least once a month in person, and that people on the drugs should also be prescribed a long-acting opioid, such as methadone or suboxone, widely used therapies for opioid addiction.
The college said the proposed changes would “strengthen expectations for physicians who prescribe safer supply medications” and help prevent the drugs from being used by people for whom they aren’t prescribed.
“The diversion of safer supply medication raises serious concerns for patient and public safety,” said Dr. Nancy Whitmore, registrar and CEO, in a release. “These amendments… represent meaningful regulatory action within CPSO’s mandate to serve in the public interest.”
Hamilton resident Aaron Simkin, who says prescription opioids helped stabilize his life after many years of homelessness and drug use, called the pause “good news.”
Simkin lived at the Hamilton YWCA for four years, and spent most of his time looking for drugs to fuel his addictions. Now, he has an apartment, five cats and four part-time jobs, and credits prescription opioids for helping turn his life around.
“It just stabilized my life because I didn’t need to score any drugs,” said Simkin, 47. “You don’t have to run around looking for people to buy from and… worrying [about getting] fake drugs or fentanyl.
“There’s no chaos.”
Simkin picks up his prescription, which includes Dilaudid to treat opioid dependence, once a day. He takes the medication every four to five hours, a routine that staves off the physical symptoms of withdrawal. “I’m not getting high. It’s just maintaining,” he said.
Simkin said the proposed changes would drastically affect his daily routine and lead to long stints where he can’t access the drugs, during the hours the pharmacy is closed. He’s scared he won’t be able to continue to hold down work while in withdrawal, and worries he could return to the black market to make it through.
“It’s so hypocritical,” he told CBC Hamilton in a Friday interview in a coffee shop near his apartment. “They talk like taking drugs off the street is ‘community safety,’ but they create a vacuum. They create a black market. It’s not safe. The drugs aren’t safe.”
In devising the proposed new regime, CPSO says it consulted with “physicians with expertise in addiction medicine and health system partners, including the Office of the Chief Medical Officer of Health.”
Rami Safi, a Hamilton pharmacist with several clients who receive these medications, does not believe adequate consultation occurred.
Safi, manager of Wellness Wave pharmacy near Ottawa and Barton streets, said that in addition to impacting patients, the changes also affect pharmacies, social workers and others who provide care for drug users, groups that do not appear to have been consulted.
Rami Safi stands in front of his pharmacy, Wellness Wave, on Barton Street East in Hamilton on Friday, Nov. 13, 2026. (Saira Peesker/CBC)
He said he often sees complaints on social media about drug users loitering around pharmacies, and said the proposed change was bound to increase tension between pharmacies, their customers and others in their neighbourhoods.
“It’s going to make it worse because people will just hang out around the pharmacy” between their doses, he said. “This has created so [many] problems for me and for my colleagues across the city. It’s an extra pressure that we don’t need in these situations.”
Safi, who is also a psychotherapist, believes stricter rules — such as the proposed change to safe-supply prescriptions — come from a place of moral judgement of people who use drugs, rather than an approach that would best address the crisis.
“We see it as morality because the consequences of using drugs might lead to crime,” he said. “When you see it in your own personal life, you know that it’s actually way deeper than that. It’s biological factors, it’s social factors and it’s psychological factors.”
After safer-supply prescriptions allowed many drug users to function better within mainstream society, Safi worries the new changes will push them back to the margins.
He’d like to see the health care system redirect its efforts toward better treating the mental-health conditions of people who use drugs, and better-integrated health care where a patient’s various practitioners — including doctors, social workers, pharmacists and mental health experts — could work as a team with a shared approach.
Safi pointed to the shocking number of people who have died from opioid toxicity in Canada — 57,509 between January 2016 and March 2026, according to Statistics Canada.
“If you have an army fighting somewhere, you will not lose this number,” he said. “Do we ditch them and just say, ‘Let them die’? That’s what we’re kind of doing in a way. Or do we have to find real proper solutions and access to care?”
