Substance Use Disorder in Canada: Harm Reduction and the Future of Community-Based Care

Canada’s overdose crisis continues to worsen. Front-line healthcare providers across the country report a more toxic drug supply, rising demand for services, and ongoing stigma that blocks access to care. While public debate often focuses on ideology, experts working directly in communities say effective solutions already exist. The real challenge is sustaining them.

During a national panel discussion, healthcare leaders from Toronto, Winnipeg, Halifax, Vancouver, and Saskatchewan shared what they see on the ground and what must change to improve outcomes for people living with substance use disorder.

Harm Reduction Under Political Pressure

Harm reduction services face increasing political scrutiny, even as research continues to demonstrate their effectiveness. Maryam Ebrahimpour, Assistant Executive Director and Senior Director of Primary Health Care at Regent Park Community Health Centre, said policy decisions directly affect patient access.

“These politicized narratives are hindering treatment and access for our clients,” Ebrahimpour said. “Harm reduction needs to be a cornerstone of mental health treatment, supported by equitable policy and sustainable funding.”

She explained that consumption and treatment services often act as an entry point to the healthcare system. These programs connect people to primary care, mental health services, housing supports, and employment resources, particularly in marginalized communities.

Meeting People Where They Are

Panelists emphasized that low-barrier, community-based care remains essential. Outreach teams regularly meet people in encampments, shelters, and public spaces, often providing the first point of contact with the healthcare system.

In Winnipeg, Crystal Cyr, Director of the Rapid Access to Addictions Clinic at the Aboriginal Health and Wellness Centre of Winnipeg, described an Indigenous-led model that centres dignity and choice. “We don’t refer to people as patients. We call them constituents,” Cyr said. “They have a say in their own health care. We’re walking alongside them, not leading them.”

Her organization recently launched a mobile clinic that delivers addictions and primary care services directly in the community. “Safe consumption saves lives. We know this,” Cyr said. “The challenge is helping people understand why these services matter.”

Geography and Access Gaps

Access to addictions care remains uneven across Canada, especially in rural and northern communities. Cyr described how individuals often travel long distances to stabilize on medications, staying in hotels for weeks while attending daily appointments.

“You can imagine how stressful it is to be away from your home, your children, your family,” she said. “There has to be a better way.”

In Atlantic Canada, Jeffery Liberatore, Assistant to the Manager at the Overlook in Halifax, described similar pressures. “We started with eight people in our caseload. We now have 3,000,” he said, pointing to housing shortages and limited access to primary care outside urban centres.

Housing as Health Care

At the Overlook, supportive housing serves as a core health intervention. The site combines housing with onsite primary care, pharmacy services, and social work supports. Liberatore said this integrated approach reduces isolation and improves safety.

“The intention is to build a neighborhood where people have eyes on each other and support each other,” he said. Tenants receive training in overdose response and naloxone use. “People aren’t using alone behind closed doors. There’s an immediate response when something happens.”

Moving Beyond Stigma

On the West Coast, Michelle C. Danda, Clinical Nurse Specialist with Vancouver Coastal Health, said misunderstanding continues to shape public perceptions of harm reduction.

“Harm reduction is a range of services,” Danda said. “It’s not just supervised consumption or safer supply. It’s about meeting people’s needs across the continuum of care.”

She added that stigma remains a major barrier, even in regions with well-established programs. “Health care decisions should be driven by evidence, not personal or political viewpoints,” Danda said.

Building Public Support Through Evidence

Panelists agreed that public support increases when communities understand outcomes. Integrated harm reduction and treatment models reduce overdose deaths, ease pressure on emergency departments, and improve community stability.

“We saw with COVID that we can work together to solve complex problems,” Danda said. “This crisis deserves the same urgency.”

Despite regional differences, the panel reached a shared conclusion. Community-based, non-judgmental, and evidence-informed care saves lives. The challenge now is not innovation, but long-term commitment.

As Cyr put it, “If we want different outcomes, we have to keep saying yes to care, yes to dignity, and yes to meeting people where they are.”

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