After the Ford government declared supervised consumption sites (SCS) were causing more harm than good, researchers and community workers say the province’s new model for treating addiction isn’t offering a clear path for people to actually get help, with advocates urging changes to the abstinence-based plan.

Responding to community backlash, the province introduced legislation banning the operation of supervised consumption sites near schools and playgrounds, while cutting funding to others. Many locations forced to closed shifted their operations to the province’s Homeless and Addiction Recovery Treatment (HART) Hubs.

However, many community workers said a year after those locations opened their doors, there isn’t a clear indication of what has changed other than outlawing drug use within the areas and ending harm reduction programs like needle exchanges.

“They don’t even seem to be providing what they’re supposed to be providing, which is recovery,” said community worker Diana Chan McNally, noting the HART Hubs aren’t expediting people into recovery programming. She said many people finishing detox programs are being set up for failure after being told they need to remain drug-free while waiting months on wait-lists for recovery beds.

The Ministry of Health said since opening, HART Hubs have delivered over 100,000 client interactions and provided hundreds of people with supportive housing and addiction recovery beds. Chan McNally disputes this, saying most of the hubs operating in the city are only offering drop-in programs where people can seek counselling, do laundry, and get food.

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A ministry spokesperson told Global News that the province is adding close to 900 supportive housing units and nearly 350 addiction and recovery treatment beds through the HART Hub model. But they couldn’t clarify how many of those treatment beds are being put into service in Toronto, since each location determines what services it will have based on local need.

Public health researcher Gillian Kolla, from Memorial University, said outreach interviews were done in each of the communities where supervised consumption sites were closed in favour of HART Hubs. Those interviews, Kolla said, saw many respondents unclear about what services were available.

“Overwhelmingly we’re hearing about no improvements to detoxification or drug treatment programs, people are still being put on wait-lists as they were before,” said Kolla.

“They’re also not reporting any increases to housing availability.”

2:19
Help on Wheels: New HART Hub outreach program brings mental health care to rural communities

There is also continuing concern over the lack of drug testing once available at supervised consumption sites, a service outlawed at HART Hubs. It’s a major gap that coincides with a toxic drug supply where Toronto’s top doctor said people are often unaware what they’re actually ingesting.

“Through our drug checking, we see that almost 80 per cent of substances that people thought was fentanyl actually contains other things like medetomidine, an animal tranquilizer that’s not approved for humans and is also not responsive to things like naloxone,” said Toronto Medical Officer of Health Dr. Michelle Murti.

Murti added that overdoses may have been on the decline in 2025, but since late last year they’ve been steadily rising month-over-month.

While many say HART Hubs aren’t doing enough, they aren’t writing them off altogether. In fact, many in the harm reduction field said they had been pushing for their introduction to help treat addiction in concert with supervised consumption sites.

Bill Sinclair heads up the Neighbourhood Group, which successfully got a court injunction to continue running its supervised consumption site near Kensington Market. He said since the Ford government closed other sites, his location, the only remaining supervised consumption site west of Yonge Street, has seen twice as many clients.

Sinclair is adamant addiction treatment doesn’t need to be an either/or choice between a supervised consumption site and a HART Hub.

“HART Hubs are meant to support people while they go through this waiting and that’s important, but it doesn’t reverse overdoses,” he said, “and today, people need to live to be on a waiting list.”

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Ontario will not have a policy in place to publicly fund all medically necessary services from nurse practitioners by April 1, as ordered by the federal government, leaving some patients paying out of pocket for primary care.

Health Minister Sylvia Jones pushed the federal government years ago to close what she called a loophole in the Canada Health Act that allowed some nurse practitioner clinics in the province to charge patients fees for primary care.

The government has done that, clarifying that nurse practitioner services equivalent to what physicians provide are covered by the Act’s requirement that medically necessary services are publicly funded. It has given provinces and territories the April 1 deadline — but Ontario won’t be ready.

“The Ministry of Health is actively reviewing and engaged in ongoing discussions with provincial and territorial partners and the federal government regarding implementation expectations of the federal government’s direction,” spokesperson Ema Popovic wrote in a statement.

Provinces won’t start incurring penalties for non-compliance until April 2027. Critics and nurse practitioners say Ontario should not wait.

“The (federal government’s) letter really underscores the importance of the provincial government’s immediate implementation of a robust, sustainable funding mechanism to support nurse practitioners as key members of health-care workforce,” said Michelle Acorn, CEO of the Nurse Practitioners Association of Ontario. “The lack of easily accessible funding models has historically limited the number of public positions and practice settings for nurse practitioners in Ontario.

“Flexible funding mechanisms will support nurse practitioners in delivering the timely, high-quality, accessible care that Ontarians deserve where and when they need it.”

Nurse practitioners in Ontario can assess patients, order and interpret tests, and prescribe medication and treatment. They work in a variety of settings, including family health teams and community health teams, hospitals and long-term care homes, as well as in more than two dozen publicly funded nurse practitioner-led clinics.

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Two years ago, a proliferation of private subscription fee-based nurse practitioner clinics made headlines. Jones responded to opposition and media questions by putting the onus on the federal government to close a “loophole” that allowed them to operate.

“If there is a wedge that is allowing these clinics to happen, then perhaps the member opposite could pick up the phone and call their federal counterparts, because that’s what I’ve been doing,” she said in question period in March 2024.

“I’m making the case that if the Canada Health Act allows these for-profits, then we will be shutting them down with the changes to the Canada Health Act and federal government involvement.”

Ontario Liberal health critic Dr. Adil Shamji said it is “hypocritical” for Jones to now delay the implementation of what she so strongly urged two years ago.

“To me it suggests that it has always been more convenient for this government to allow patients to pay out of pocket than to fund it within our public medicare,” he said.

“We know that exceptional primary care can be delivered by nurse practitioners, and there is no reason that, if they are providing a service that would otherwise be covered if delivered by a physician, there’s no reason that it shouldn’t be covered under our public health-care system as well.”

Nurse practitioner Maryanne Green, along with two nurse practitioner colleagues, operates one of the subscription-based clinics Jones had threatened to shut down.

She applied to run a publicly funded clinic in 2023, when the government put out an expression of interest for new primary care teams, but was turned down. Green decided to open a clinic anyway, given the high need for primary care she saw in her community of Kingston, Ont.

“It’s frustrating,” Green said. “I am not charging because I want to. It’s because this is the only way to move forward.

“From the point where I put that proposal in and recognizing that OK, I’m not going to get funding, the options are to sit back and wait until either I get (Ontario Health Insurance Plan), continue trying for funding, or I move forward with the private business plan.”

Green’s clinic has urgent care services, as well as an annual membership of $1,800 for primary care. She hopes that when Ontario comes out with its plan for funding nurse practitioners, it is at an adequate level.

“I absolutely want public funding, and want to be able to provide patients with hopefully free access to health care,” she said.

“I am concerned that we’re not going to get enough funding to run a clinic like this properly. We know that there’s inherent issues within the existing models where you’ve already heard family physicians complain that they’re not making enough money with the OHIP billing process as it is, that they feel their administrative burden is too high.”

Currently in most settings, nurse practitioners are paid a salary, though rates tend to be higher in hospitals, for example, which can make recruiting and retaining nurse practitioners in existing publicly funded primary care settings challenging, Acorn said.

In addition to seeing better compensation for the nurse practitioner positions that are already publicly funded, the association wants to see flexible funding models, such as those for family doctors, who can bill OHIP on a fee-for-service basis or who are paid per patient enrolled.

NDP primary care critic Dr. Robin Lennox said the government should work to fully integrate nurse practitioners into the primary care system, as it works toward a goal of attaching all Ontarians to primary care by 2029.

“I would like to see enough flexibility in the funding model that our nurse practitioners are able to function as they have been trained, which is as independent primary care providers, particularly in, you know, our rural and remote regions where access to primary care is more limited,” she said.

“This is a really huge opportunity to prevent nurse practitioners from having to enter into essentially a private-payer system just to be able to provide the primary care they’re trained to deliver.”

As some Ontarians remain without a family doctor, a new study shows not having one can increase your risk of death, but it found the risk is even higher for those with multiple chronic conditions the longer they’re without.

According to the study, those with multiple chronic conditions who went without a family doctor for two or more years had 12-fold higher odds of death, and a nearly 16-fold higher chance of premature death.

“So people with multiple chronic conditions who do have a family doctor compared to similar people in all other ways with multiple chronic conditions and the only real difference being they don’t have a doctor, (of) those two groups, there was double the risk of dying in the next year,” said Jonathan Fitzsimon, lead author of the study.

The study was published in the Health Affairs Scholar journal this month and saw more than 12 million Ontarians’ health records analyzed.

Of that 12 million, approximately 90 per cent or 11.5 million had a family doctor, with 83 per cent having had their physician for five years or more. The remaining 1.2 million did not have a family doctor, with the study finding roughly one-third being without one for five years or more, and 7.4 per cent without a physician for 15 or more years.

That’s a problem because when those who may need that primary care don’t get it, it can mean more burden on the health-care system.

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“Maybe there needs to be a focus as well, and some degree of priority and additional work on those unattached patients who have multiple chronic conditions, because they’re the ones who are at the most risk individually, but they also have the highest burden on our hospital system,” Fitzsimon said.

A separate study conducted by Fitzsimon and four other researchers found prolonged periods without primary care were “significantly associated” with increased health-care costs. Those with high comorbidities without a family doctor for a long period of time had a median cost of about $8,100 annually.

2:28
Health Matters: 6M Canadians still do not have access to primary care, survey suggests

He noted the study also showed the risk for those with multiple health issues went up in the years after they lost their family doctor, especially within the first five years.

“People with chronic conditions, well-controlled, well-managed, their medications ordered, their prescriptions refilled on time, and then they lose their family doctor and now they’re having to manage these chronic conditions independently or without professional support,” Fitzsimon said.

“That leads to more emergency department visits, more hospital visits, and what we also found now in this new research, a higher association with mortality.”

Fitzsimon applauded efforts by the provincial government to get Ontarians access, noting their Primary Care Action Plan, but said action should still be taken on ensuring care gets to those who may need it the most.

Dr. Tara Kiran, a family physician at St. Michael’s Hospital in Toronto, said not having a family doctor can pose added issues when a patient has several health issues.

“You end up going for a lot of your care to walk-in clinics or emergency departments, and those settings are actually designed to just deal with an immediate issue,” Kiran said. “They don’t provide ongoing follow-up, and it’s not really their job to manage chronic conditions over time.”

She said while these facilities can refer you to specialists, such as an endocrinologist for diabetes, it would only manage “one part of you.”

“Very different from a family doctor that manages the whole of you and balances all of those chronic conditions and your many needs,” she added.

While Kiran agrees with the need to get those with chronic conditions a family doctor first, it can be difficult to ensure they are reached due to barriers they may face.

She said the focus needs to be getting everyone care.

“In theory, we should be trying to prioritize, but in practice that’s hard and that’s why I also support the efforts to just ensure that everyone has one (a family doctor) because if we get that to everyone, that will include the people who are complex too,” Kiran said.

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