This letter was sent to Ontario’s Big City Mayors to express grave concern with the organization’s August 16 announcement encouraging the Ontario government to allow for involuntary medical treatment.
August 20, 2026
Mayor Marianne Meed Ward, Chair
Angela Trewartha, Executive Director (Acting)
Re: Response to Reaction to Recovery Campaign
Dear Representatives of Ontario’s Big City Mayors,
Ontario is facing an undeniable crisis. Thousands of people are dead because of an increasingly toxic and unpredictable unregulated drug supply. Homelessness has reached extraordinary levels, while many people face significant barriers to accessing and remaining connected to substance use treatment, housing, harm reduction, and other supports, particularly as critical services close. Meanwhile, municipalities are being asked to respond to complex health and social needs that cannot be addressed through municipal resources alone.
We therefore share the urgency expressed in your Reaction to Recovery campaign. Ontario urgently needs greater investment in accessible healthcare, voluntary substance use treatment, supportive and affordable housing, harm reduction, mental health services, and other social supports.
We are, however, deeply concerned by the call for expanded involuntary treatment as a response. We understand the impulse to “do something.” Communities are witnessing preventable deaths, growing homelessness, and increasingly visible public drug use given the closures of supervised consumption services. Governments are under pressure to respond. But urgency cannot justify abandoning the fundamental rights of people who use drugs in service of an intervention that has not even been shown to work.
2. Forced treatment is a profound infringement of human rights
Involuntary treatment gives the state extraordinary power to deprive people of their liberty and override decisions about their own bodies and healthcare. People who use drugs do not lose their rights to liberty, dignity, autonomy, and informed consent simply because others disagree with their choices or believe treatment is in their best interest.
Human rights bodies have repeatedly raised concerns about these practices in Canada. The UN Committee on the Rights of Persons with Disabilities has called on Canada to repeal laws and policies permitting involuntary detention and treatment, including for substance use. The UN Working Group on Arbitrary Detention has similarly cautioned against coercing people into drug treatment, while the UN Human Rights Committee recently called on Canada to ensure that people are not detained solely because of drug use, that treatment is voluntary, and that medical interventions require informed consent. Canadian courts have also recognized the serious Charter implications of overriding healthcare consent in the context of involuntary psychiatric treatment.
There is also no compelling evidence that overriding these fundamental rights actually works. Your campaign refers to “successful models across Canada,” but does not identify them or provide evidence of their success. The available research remains limited and conflicting and does not establish that involuntary treatment produces better or more sustained outcomes than voluntary care.
Some studies suggest that coerced treatment may lead to poorer long-term outcomes. Other studies suggest that coerced treatment increases mortality and morbidity. For instance, an evaluation from the U.S. found that people who underwent involuntary treatment were more than twice as likely to die from an overdose as those who completed voluntary treatment. Forced abstinence can reduce drug tolerance, leaving people at heightened risk of overdose after discharge into an increasingly toxic drug supply.
Such a profound intrusion on people’s rights cannot be justified by an intervention that has not been shown to work and may, in fact, cause serious harm.
2. Ontario’s policies have made people less safe
The worsening conditions described in your campaign did not arise in a vacuum and are no surprise to those who are working on the frontlines of intersecting crises. Over the last two years, Ontario has made housing less secure for people who use drugs, supported the clearing of encampments, expanded police powers to target public drug use despite evidence of the harm it causes, and closed critical health services relied upon by people who use drugs.
Stability matters. Losing housing can disrupt the routines and relationships that allow people to attend appointments, fill prescriptions, access services, care for family, and stay connected to support. Displacement compounds that disruption, while stigma and criminalization create further barriers to care. Homelessness, poverty, and incarceration are also associated with higher rates of overdose and overdose death. Policies that increase housing insecurity, displacement, and criminalization do not resolve the homelessness and toxic drug crises but instead entrench the conditions that make both harder to address.
These harms are not experienced equally. Indigenous and racialized people face disproportionate harms from the toxic drug supply, homelessness, systemic racism, and criminalization, while women and gender-diverse people who use drugs experience higher rates of gender-based violence and homelessness. The recent closure of YWCA Hamilton’s Safer Use Space shows how these crises intersect: the Safer Use Space served 611 women and gender-diverse people and responded to 167 drug poisonings without a single death before funding was pulled in July 2026. Dismantling such supports, while simultaneously expanding coercion, risks further marginalizing people already facing multiple barriers to housing, care, and safety.
Yet this is precisely the direction the Government of Ontario has taken: greater housing insecurity, more displacement, more criminalization, and fewer points of connection to care. It is difficult to reconcile that approach with a stated desire to address worsening homelessness and substance use crises.
3. We know what works
Rejecting involuntary treatment does not mean accepting the status quo. We know what works: a spectrum of accessible options grounded in dignity, autonomy, and consent.
That means voluntary, evidence-based drug treatment for people who want it, alongside housing, healthcare, and other social services. It means reducing the harms associated with the toxic drug supply and meeting people where they are, regardless of their drug use.
The evidence for supervised consumption services is particularly strong. They prevent and reverse overdoses, reduce public drug use and discarded syringes, connect people to healthcare and other services, and do not increase drug-related crime. They can also be a pathway to treatment: research has found that people who use supervised consumption services are more likely to access addiction treatment and other healthcare and social services. Between March 2020 and November 2024 alone, Ontario’s supervised consumption services reversed approximately 22,000 overdoses.
Harm reduction and treatment are not competing approaches. We need both. We need to ensure that people have meaningful options and the supports to access them — not take those choices away.
A different way forward
For decades, people who use drugs have been stigmatized, criminalized, displaced, and pushed to the margins. We urge Ontario’s Big City Mayors not to repeat that history by endorsing greater coercion in the name of care.
You have an important opportunity to demand a different response from the province: one that embraces people who use drugs and affirms that their lives, dignity, and choices matter. That means rejecting policies that push people further from housing, healthcare, and community, and investing instead in services that people can trust and want to access.
We urge you to reject the Ontario government’s renewed war-on-drugs approach and use your collective voice to demand a return to harm reduction and meaningful investments in housing, healthcare, voluntary treatment, and community-based supports.
Ontario does need urgent action. But that action should bring people closer to care, not subject them to greater coercion; strengthen their connections to community, not further marginalize them; and respect their autonomy, not take it away.
Sincerely,
Sandra Ka Hon Chu and Janet Butler-McPhee
Co-Executive Directors, HIV Legal Network