{"id":25457,"date":"2025-12-18T08:54:33","date_gmt":"2025-12-18T13:54:33","guid":{"rendered":"https:\/\/www.hivlegalnetwork.ca\/site\/?post_type=publication22&p=25457"},"modified":"2026-03-09T15:22:30","modified_gmt":"2026-03-09T19:22:30","slug":"urgent-concerns-regarding-cscs-recent-opioid-agonist-treatment-policy-changes-open-letter","status":"publish","type":"publication22","link":"https:\/\/www.hivlegalnetwork.ca\/site\/urgent-concerns-regarding-cscs-recent-opioid-agonist-treatment-policy-changes-open-letter\/","title":{"rendered":"Urgent Concerns Regarding CSC\u2019s Recent Opioid Agonist Treatment Policy Changes – Open Letter"},"content":{"rendered":"Sign the letter here<\/a>.<\/em><\/p>\n

15 December 2025<\/p>\n

Via email<\/strong><\/p>\n

Anne Kelly, Commissioner, <\/strong>Correctional Service Canada (CSC)
\nMarie Doyle, Assistant Commissioner, Health Services, CSC
\n<\/strong><\/p>\n

cc: Bassem Guirguis, National Pharmacist, CSC; Darcy Stoneadge, Director, Health Policy and Programs, CSC; Dr. Asim Masood, Chief Medical Office of Health, CSC; Dr. Guy H\u00e9bert, National Physician Lead, CSC; Dr. Nader Sharifi, National Advisor Opioid Agonist Treatment, CSC ; Ginette Clarke, Manager, Institutional & Community Mental Health Services, CSC<\/p>\n

Re: Urgent Concerns Regarding CSC\u2019s Recent Opioid Agonist Treatment (OAT) Policy Changes<\/strong><\/p>\n

Dear Commissioner Kelly and Assistant Commissioner Marie Doyle,<\/p>\n

We write as clinicians, addiction-medicine specialists, and health researchers working in substance use care and correctional health across Canada. We are deeply alarmed by Correctional Service Canada\u2019s (CSC) recent policy change designating extended-release buprenorphine (XR-BUP or Sublocade) as the first-line opioid agonist treatment (OAT) option available in federal institutions (\u201cnew OAT policy\u201d), while removing buprenorphine\/naloxone (BUP\/NAL or Suboxone) from the open-formulary.<\/p>\n

Under the new OAT policy, Sublocade is positioned as the \u201cpreferred\u201d treatment option for opioid use disorder (OUD). BUP\/NAL is no longer an open-formulary medication and must now be accessed through a restrictive and non-formulary request\u00a0\u2013 an opaque process to patients. For those who cannot secure approval through this process, BUP\/NAL would have to be paid for out of pocket, which is not feasible for most people in custody. Methadone remains on the formulary, but early reports from clinicians and patients suggest that methadone is now available only under very limited circumstances, effectively inaccessible for most people who are not already on it.<\/p>\n

While Sublocade is an effective and preferred option for some patients, no national or international guideline recommends it as the sole or preferred first-line treatment. Limiting access to BUP\/NAL and methadone, by adding procedural hurdles, contradicts well-established standards of care, undermines patient autonomy, and creates foreseeable clinical risks. Reports from incarcerated people, since October 2025, indicate that the new OAT policy is already resulting in forced transitions, inadequate informed consent, and avoidable harms. We also have concerns around the evidence relied upon in developing the police and the nature of any industry influence.<\/p>\n

We strongly urge CSC to pause implementation, reinstate access to the full range of OAT options based on the standard of care in the community \u2014 in keeping with section 86 of the Corrections and Conditional Release Act<\/em>, which requires CSC to provide essential health care in conformity with \u201cprofessionally accepted standards\u201d and the Mandela Rules<\/em>,[1]<\/sup><\/a> which require equivalence of care for people deprived of liberty \u2014 and establish an independent review of the OAT policy.<\/p>\n

    \n
  1. Patient Autonomy, Coercion, and Safety<\/strong><\/li>\n<\/ol>\n

    The new OAT policy formalizes the erosion of patient autonomy and encourages coercive treatment practices.<\/p>\n

    As described in CSC materials, BUP\/NAL is no longer an open-formulary medication and can be accessed only through a non-formulary request requiring a prescriber to attest that it is the \u201conly medication\u201d<\/em> that would work for the patient. It remains unclear what prescribers consider a valid clinical justification, on what basis this assessment should be made, and whether people in custody are being informed regarding how to initiate the process at all. This process also creates delays in timely treatment initiation or continuation for anyone seeking access to a medication that is no longer on the formulary. Since at least October 2025, we have heard multiple reports of people being forced or pressured to switch from BUP\/NAL to Sublocade despite clear preferences to remain on their existing therapy, with some experiencing increased cravings or destabilization after being switched involuntarily. At the same time, recent reports from clinicians and people in prison indicate that methadone initiation appears to be permitted only in very limited circumstances. As a result, most people are unable to access either first-line OAT option unless they are pregnant or allergic to Sublocade.<\/p>\n

    CSC documentation also suggests that people who decline switching to Sublocade (absent pregnancy or allergy) may be \u201csupported\u201d to stop OAT altogether. This amounts to coerced detoxification. National OUD guidelines explicitly warn against detox-only approaches due to sharply elevated risks of relapse, overdose, and death.[2]<\/sup><\/a> Conditioning access to standard-of-care treatment on accepting an injectable formulation is coercive, clinically inappropriate, and dangerous.<\/p>\n

    We have also heard reports of individuals being told they must accept Sublocade \u201cor get nothing at all,\u201d of questions or concerns being dismissed, and of people receiving little or no information about the risks, side effects, or alternatives. These practices violate the right of people in custody to a standard of care equivalent to that available in the community, where both methadone and BUP\/NAL remain first-line, guideline-recommended options.<\/p>\n

      \n
    1. Clinical and Scientific Concerns<\/strong><\/li>\n<\/ol>\n

      CSC\u2019s policy is inconsistent with every major OUD treatment clinical guideline. Canadian, U.S., and European guidelines all identify methadone and BUP\/NAL as co-equal first-line therapies.[3]<\/sup><\/a> None recommend Sublocade as the sole first-line option. The College of Family Physicians of Canada\u2019s position statement on OAT in prison likewise emphasizes that people in custody must have access to all evidence-based OAT medications.[4]<\/sup><\/a><\/p>\n

      As noted above, CSC\u2019s policy also raises concerns under its statutory duties to provide health care that meets professionally accepted standards and to support independent, patient-centered clinical judgment.[5]<\/sup><\/a> A model that restricts access to guideline-recommended first-line treatments is difficult to reconcile with these obligations.<\/p>\n

      The available clinical evidence does not support elevating Sublocade into a single first-line treatment. Multiple studies demonstrate worse treatment retention with Sublocade than with BUP\/NAL, and buprenorphine of any form has retention outcomes equal to or lower than methadone.[6]<\/sup><\/a> Treatment retention is among the strongest predictors of improved health outcomes[7]<\/sup><\/a> restricting access to medications with stronger retention profiles risks destabilizing individuals whose current therapy is effective.<\/p>\n

      The scientific foundation CSC has cited is also limited.[8]<\/sup><\/a> A central systematic review included only ten studies: many small, heterogeneous, non-randomized, and short in duration, including XR-BUP formulations not currently available in Canada.[9]<\/sup><\/a> The lead author (and signature to this document) has clarified that the review findings support Sublocade as an additional option \u2014 not a replacement for existing first-line therapies. Another cited U.S. study involved a predominantly heroin-using population, making the findings difficult to extrapolate to Canada\u2019s fentanyl-dominated context.[10]<\/sup><\/a> Moreover, the study provided markedly different levels of post-release support across treatment groups: individuals receiving Sublocade were offered free, ongoing injections and follow-up, whereas those receiving sublingual buprenorphine were given only a seven-day supply. These structural differences confound any differences observed in treatment outcomes.<\/p>\n

      Even when clinically appropriate, many people receiving Sublocade require supplemental BUP\/NAL to manage cravings or withdrawal.[11]<\/sup><\/a> CSC\u2019s guidance acknowledges this need only narrowly, allowing prescribers to provide supplemental buprenorphine\/naloxone during induction. However, the policy offers no mechanism for supplementation beyond that stage, despite real-world evidence that ongoing supplemental dosing is often necessary. As a result, clinically necessary adjustments may be impossible to meet under the current framework.\u200b<\/p>\n

      Since at least October 2025, people inside federal institutions have also reported painful injections, inadequate preparation or monitoring, large injection-site masses, severe allergic reactions, and trauma or fear related to injection. Some described the immediate return of cravings after involuntary transition. These experiences underscore that Sublocade is not appropriate as a universal first-line treatment and should never be imposed without proper assessment, consent, or alternatives.<\/p>\n

      Taken together, the evidence does not support restricting access to BUP\/NAL or methadone, two long-standing, evidence-based first-line OAT options. Doing so effectively creates a single-medication OAT system that is inconsistent with clinical standards and introduces predictable risks \u2014 including destabilization of people who are stable on their current therapy, reduced treatment retention, unmanaged withdrawal or cravings, and heightened vulnerability to relapse and overdose. CSC\u2019s approach overstates the strength of the existing evidence and disregards the well-documented harms that arise when people are denied access to the full range of evidence-based OAT options.<\/p>\n

        \n
      1. Pharmaceutical Influence and Cost Concerns<\/strong><\/li>\n<\/ol>\n

        We have concerns around transparency in the development of this new OAT policy, particularly given reports of strong lobbying by Indivior, the manufacturer of Sublocade. Sublocade is the only OAT medication without a generic equivalent and is significantly more expensive than methadone or BUP\/NAL.[12]<\/sup><\/a> These concerns are heightened by Indivior\u2019s history of regulatory settlements related to misleading marketing and anti-competitive behaviour.[13]<\/sup><\/a><\/p>\n

        Ensuring that procurement processes, evidence assessments, and policy decisions are independent, evidence-based, and free from undue industry influence is critical, particularly given CSC\u2019s commitment to enhancing transparency and credibility in its interactions with Canadians, including through clear communication on issues of public concern.[14]<\/sup><\/a><\/p>\n

          \n
        1. Systemic and Operational Concerns<\/strong><\/li>\n<\/ol>\n

          The new OAT policy also raises significant operational concerns, particularly around implementation and continuity of care. Reports from institutions describe considerable confusion about how the policy is being applied, wide variability in how information is communicated to patients, and inconsistent adherence to injection protocols. These issues heighten the risk of adverse events and undermine the safe delivery of care.<\/p>\n

          Continuity of care during release planning is another major concern. Many individuals on parole remain tied to CSC-funded health services and therefore continue to have access only to Sublocade, even when their community lacks providers trained or authorized to administer it. This creates foreseeable gaps during the period of highest overdose risk and makes sustained stabilization far more difficult.[15]<\/sup><\/a> Sublocade\u2019s cost (approximately $700+ per injection) further creates barriers to continued treatment following release, particularly in provinces and territories where coverage is limited or requires prior authorization, raising additional concerns about long-term sustainability.<\/p>\n

          While some correctional staff have cited potential operational benefits, such as reducing diversion or alleviating pressures associated with daily observed dosing, these challenges call for strengthened health services and not the removal of widely accepted, evidence-based treatments.<\/p>\n

          Recommendations<\/strong><\/p>\n

          We urge CSC to:<\/p>\n

            \n
          1. Reinstate full access to methadone and BUP\/NAL as standard first-line OAT options.<\/li>\n
          2. Pause implementation of Sublocade as first-line OAT option pending an independent clinical and ethical review.<\/li>\n
          3. End coercive practices, including threats of detox or removal of OAT.<\/li>\n
          4. Ensure meaningful informed consent, including information on risks, alternatives, and injection procedures.<\/li>\n
          5. Strengthen clinical training, oversight, and monitoring for Sublocade administration.<\/li>\n
          6. Engage external addiction medicine experts, researchers, and people with lived experience to ensure OAT policy development is in line with standards of care in the community.<\/li>\n
          7. Take steps to support continuity of care for BUP\/NAL, methadone, and Sublocade, so that people can maintain their existing OAT regimen on entry to custody and upon release, without treatment interruptions.<\/li>\n
          8. Commission an independent review of procurement processes, evidence sources, and clinical governance, and take steps to ensure transparency regarding the evidence relied on and any manufacturer engagement.<\/li>\n<\/ol>\n

            We remain ready to work collaboratively toward an evidence-based, patient-centred OAT model that respects autonomy, ensures equivalency of care, and aligns with national clinical standards. The current policy introduces significant medical, ethical, and human-rights risks that require urgent attention.<\/p>\n

            Sincerely,<\/p>\n

            Safina Adatia, Addiction Medicine Physician, Ottawa Hospital, Sioux Lookout Meno Ya Win Health Centre
            \n<\/strong>Ottawa, ON<\/span><\/p>\n

            Sajida Afridi, Assistant Professor, Department of Family Medicine, Queen’s University
            \n<\/strong>Whitby, ON<\/p>\n

            Diana R. Ahmed, MD, CCFP, FCFP,<\/strong> Assistant Clinical Professor, McMaster University
            \n<\/strong>Hamilton ON<\/p>\n

            Bakir Al Tikriti, MD
            \n<\/strong>Calgary, AB<\/p>\n

            Farihah Ali, Scientific Lead, PhD,<\/strong> Centre for Addiction and Mental Health
            \n<\/strong>Toronto, ON<\/p>\n

            Marco Arimare, Addiction Medicine Physician, Providence Health
            \n<\/strong>Vancouver, BC<\/p>\n

            Paxton Bach, Clinical Assistant Professor<\/strong>, Department of Medicine, University of British Columbia
            \n<\/strong>Vancouver, BC<\/p>\n

            Nikki Badun, RN,<\/strong> AHS
            \n<\/strong>Edmonton, AB<\/p>\n

            Jupinder Bains, MD,<\/strong> Smart Clinic
            \n<\/strong>Calgary, AB<\/p>\n

            Benjamin Baranek, Family and Addictions Medicine Physician,<\/strong> Unity Health Toronto
            \n<\/strong>Toronto, ON<\/p>\n

            Lance Bartel, Physician
            \n<\/strong>Calgary, AB<\/p>\n

            Jaspreet Bassi, Addictions Medicine Specialist, Women\u2019s College Hospital
            \n<\/strong>Toronto, ON<\/p>\n

            Ahmed Bayoumi, Professor of Medicine, University of Toronto
            \n<\/strong>Toronto, ON<\/p>\n

            Michaela Beder, MD, FRCPC, Psychiatrist<\/strong>, University of Toronto
            \n<\/strong>Toronto, ON<\/p>\n

            Patricia Belda, MD
            \n<\/strong>Edmonton, AB<\/p>\n

            Lindsay Bennett, Pharmacist,<\/strong> The Royal Ottawa Mental Health Centre
            \n<\/strong>Ottawa, ON<\/p>\n

            Mergim Binakaj, MD<\/strong>, University of Toronto
            \n<\/strong>Toronto, ON<\/p>\n

            Claire Bodkin, MD, CCFP,<\/strong> McMaster University
            \n<\/strong>Lion’s Head, ON<\/p>\n

            Charles Bonham-Carter, MD, Chief Medical Director, Canadian Addiction Treatment Centres
            \n<\/strong>Kingston, ON<\/p>\n

            Mara Boyle, Family Physician
            \n<\/strong>Sioux Lookout, ON<\/p>\n

            Nikki Bozinoff Bozinoff, MD, MSc, CCFP(AM)<\/strong>, Assistant Professor, Department of Family and Community Medicine, University of Toronto
            \n<\/strong>Toronto, ON<\/p>\n

            Rupinder Brar, MD,<\/strong> University of British Columbia
            \n<\/strong>Vancouver, BC<\/p>\n

            Jennifer Brasch, Lead, Addiction Psychiatry,<\/strong> St. Joseph’s Healthcare Hamilton
            \n<\/strong>Hamilton, ON<\/p>\n

            David B. Bridgeo, MD<\/strong>, Erie St. Clair Clinic
            \n<\/strong>Windsor, ON<\/p>\n

            Elizabeth Brindle, Clinical Pharmacist
            \n<\/strong>Calgary, AB<\/p>\n

            Olivia Brooks, MD, CCFP(AM), DRCPSC, CISAM
            \n<\/strong>Vancouver, BC<\/p>\n

            Karen Busche, Physician,<\/strong> Shelter Health Network
            \n<\/strong>Hamilton, ON<\/p>\n

            Wai Chak Carlos Chan, MD,<\/strong> Northern Ontario School of Medicine
            \n<\/strong>Thunder Bay, ON<\/p>\n

            Claudette Chase, MD
            \n<\/strong>Neebing, ON<\/p>\n

            Jesse Chevrier, MDCM, CCFP(AM)
            \n<\/strong>Vancouver, BC<\/p>\n

            Yelena Chorny, Addiction Physician
            \n<\/strong>Guelph, ON<\/p>\n

            Lorne Clearsky, MD,<\/strong> Metrocity Clinic
            \n<\/strong>Edmonton, AB<\/p>\n

            Matt Cloutier, MD, Recovery Alberta, Acute Care Alberta
            \n<\/strong>Calgary, AB<\/p>\n

            Kate Colizza, MD, FRCPC, DRCPSC, ISAM
            \n<\/strong>Calgary, AB<\/p>\n

            Ralph Dell’Aquila, MD, CFPC,\u00a0 American Society of Addiction Medicine<\/strong>, North Bay Regional Health Centre, Assistant Professor, Northern Ontario School of Medicine
            \n<\/strong>North Bay, ON<\/p>\n

            Brittany Dennis, Physician, Clinician Scientist, Assistant Professor,<\/strong> Providence Health Care, BC Centre on Substance Use, University of British Columbia
            \n<\/strong>Vancouver, BC<\/p>\n

            Kevin Desmarais, Family Physician
            \n<\/strong>Edmonton, AB<\/p>\n

            Zo\u00eb Dodd, MES Community Scholar<\/strong>, MAP Centre for Urban Health Solutions, Unity Health
            \n<\/strong>Toronto, ON<\/p>\n

            Paul Dolinar, MD
            \n<\/strong>Toronto, ON<\/p>\n

            Joe Dooley, MD,<\/strong> MYWHC, Sioux Lookout
            \n<\/strong>Sioux Lookout, ON<\/p>\n

            Kathryn Dorman, Staff Physician,<\/strong> St. Michael’s Hospital
            \n<\/strong>Toronto, ON<\/p>\n

            Jane Dunstsn, MD, CCFP
            \n<\/strong>Calgary, AB<\/p>\n

            Julius Elefante, MD, FRCPC, ISAM (Cert.),<\/strong> University of British Columbia
            \n<\/strong>Vancouver, BC<\/p>\n

            Sarah<\/strong> Elliott, MD, MPH, CCFP(AM)
            \n<\/strong>Calgary, AB<\/p>\n

            Josh Fanaeian, Emergency Medicine Physician
            \n<\/strong>Edmonton, AB<\/p>\n

            Mike Franklyn, MD, CCFP(AM), CAC, FCFP<\/strong>, Sudbury Jail
            \n<\/strong>Sudbury, ON<\/p>\n

            Maeve Freeman-McIntyre, Nurse Practitioner
            \n<\/strong>Toronto, ON<\/p>\n

            Monty Ghosh, MD,<\/strong> University of Alberta
            \n<\/strong>Edmonton, AB<\/p>\n

            Gregory Gilmour, MD, FRCPC, Internal Medicine<\/strong>, Royal Alexandra Hospital
            \n<\/strong>Edmonton, AB<\/p>\n

            Ciarra Glass, MD
            \n<\/strong>Calgary, AB<\/p>\n

            Ritika Goel, Family Physician and Assistant Professor,<\/strong> University of Toronto
            \n<\/strong>Toronto, ON<\/p>\n

            Tara Gomes, Researcher,<\/strong> University of Toronto
            \n<\/strong>Toronto, ON<\/p>\n

            Shannon Grant, MD, CCFP
            \n<\/strong>Calgary AB<\/p>\n

            Samantha Green, Family Physician and Assistant Professor<\/strong>, University of Toronto
            \n<\/strong>Toronto, ON<\/p>\n

            Ann Griffin, Doctor,<\/strong> Water Street Clinic
            \n<\/strong>Simcoe, ON<\/p>\n

            Sarah Griffiths, MD, CCFP(AM\/EM),<\/strong> University of Toronto
            \n<\/strong>Toronto, ON<\/p>\n

            Jamie Grimshaw, Registered Social Worker, Addiction Medicine Unit
            \n<\/strong>Sudbury, ON<\/p>\n

            Meera Grover, MD, CCFP(AM), ISAM-C
            \n<\/strong>Calgary, AB<\/p>\n

            Sahii Gupta, Emergency Physician, Assistant Professor<\/strong>, University of Toronto
            \n<\/strong>Toronto, ON<\/p>\n

            Adrian Guta, Associate Professor,<\/strong> School of Social Work, University of Windsor
            \n<\/strong>Windsor, ON<\/p>\n

            James Hafichuk, Clinic Manager,<\/strong> Metro City Medical Clinic
            \n<\/strong>Calgary, AB<\/p>\n

            Alison Hamilton, Addiction Medicine Physician
            \n<\/strong>Vancouver, BC<\/p>\n

            Jessica<\/strong> Hann, MD
            \n<\/strong>Vancouver, BC<\/p>\n

            Ashley Heaslip, MD
            \n<\/strong>Victoria, BC<\/p>\n

            Haley Heist, Registered Social Worker (MSW)<\/strong>, Inpatient Addictions Medicine Consult Service
            \n<\/strong>Halifax, NS<\/p>\n

            Christina Henry, Registered Nurse,<\/strong> Rapid Access Addiction Medicine Clinic
            \n<\/strong>Thunder Bay, ON<\/p>\n

            Christin Hilbert, MD, CCFP(AM), FCFP
            \n<\/strong>Calgary, AB<\/p>\n

            Julia Hildebrand, Family Physician
            \n<\/strong>Kitchener, ON<\/p>\n

            Alexandra Hildebrand, MD, CCFP(AM)
            \n<\/strong>Brantford, ON<\/p>\n

            Jocelyn Howard, Addiction Medicine Physician
            \n<\/strong>Ottawa, ON<\/p>\n

            Ren\u00e9e M. Janssen, Clinical Assistant Professor,<\/strong> Department of Medicine, University of British Columbia
            \n<\/strong>Vancouver, BC<\/p>\n

            Lindsay Jennings, Community Investigator,<\/strong> McMaster University
            \n<\/strong>Mississauga, ON<\/p>\n

            Laura Johnson, Addiction Support Specialist<\/strong>, RSSW
            \n<\/strong>Sudbury, ON<\/p>\n

            Meldon Kahan, MD, CCFP, FRCPC, Medical Director, META:PHI (Mentoring, Education, and Clinical Tools for Addiction: Partners in Health Integration)
            \n<\/strong>Toronto, ON<\/p>\n

            Rajdeep Kandola, Family and Addictions Physician
            \n<\/strong>Calgary, AB<\/p>\n

            Mandy Karr, Nurse Practitioner, The Alex Community Health Centre
            \n<\/strong>Calgary, AB<\/p>\n

            Liana Kaufman, MD, CCFP, St. Michael\u2019s Hosptial
            \n<\/strong>Toronto, ON<\/p>\n

            Genevi\u00e8ve Kerkerian, Addiction Medicine Consultant, PHC
            \n<\/strong>Vancouver, BC<\/p>\n

            Saima Khan, CSAM-SMCA, ABPM
            \n<\/strong>Windsor, ON<\/p>\n

            Navneet Singh Khosa, MD, Family and Addiction Medicine, The Smart Clinic
            \n<\/strong>Calgary, AB<\/p>\n

            David Klassen, MD, CCFP, FRCPC
            \n<\/strong>Calgary, AB<\/p>\n

            John Koehn, Addiction Medicine Physician, Fraser Health
            \n<\/strong>Surrey, BC<\/p>\n

            Suman Koka, Physican Corrections\/Addiction Medicine Specialist
            \n<\/strong>Sudbury, ON<\/p>\n

            Gillian Kolla, Researcher, Memorial University
            \n<\/strong>St. John’s, NL<\/p>\n

            Marilyn R. Koval, MD, CCFP, FCFP, Sioux Lookout Regional Physician Services
            \n<\/strong>Sioux Lookout, ON<\/p>\n

            Thara Kumar, MD
            \n<\/strong>Red Deer, AB<\/p>\n

            Parabhdeep Lail, Physician, Alberta Health Services
            \n<\/strong>Calgary, AB<\/p>\n

            Nina Katherine Lam, MD
            \n<\/strong>Edmonton, AB<\/p>\n

            Sasha Langille-Rowe, MD, Addiction Medicine Lead
            \n<\/strong>Terrace, BC<\/p>\n

            Wes Llewelyn-Williams, Hospital Pharmacist, AHS – ACARP
            \n<\/strong>Calgary, AB<\/p>\n

            Taryn Lloyd, MD, FRCPC, Unity Health, University of Toronto
            \n<\/strong>Toronto, ON<\/p>\n

            Daniela S. S. Lobo, MD, Addiction Psychiatrist
            \n<\/strong>Toronto, ON<\/p>\n

            Erin Lurie, MD, CCFP(AM), University of Toronto
            \n<\/strong>Toronto, ON<\/p>\n

            Janis Macdonald, Nurse Practitioner, Women\u2019s College Hospital RAAM
            \n<\/strong>Toronto, ON<\/p>\n

            Ryan Maltais, Pharmacist<\/strong>, Thunder Bay Regional Health Science Centre
            \n<\/strong>Thunder Bay, ON<\/p>\n

            Talveer Mandur, MD, FRCPC, DRCPSC (Addiction Medicine)
            \n<\/strong>Toronto, ON<\/p>\n

            David C. Marsh, MD, Vice President Research and Graduate Studies, NOSM University
            \n<\/strong>Sudbury ON<\/p>\n

            David Robert Martell, Addiction Medicine Physician, Physician Lead, Addiction Medicine, Nova Scotia Health (Past President, Canadian Society of Addiction Medicine CSAM-SMCA)
            \n<\/strong>Lunenburg, NS<\/p>\n

            Sonya Martin, MD, Peterborough Regional Health Centre
            \n<\/strong>Peterborough, ON<\/p>\n

            Sara Matyas, MD, (CCFP-AM), CCSAM
            \n<\/strong>Winnipeg, MB<\/p>\n

            Zacnicte May, Addiction Medicine Physician, MD, PhD (Neuroscience), CCFP, DRCPSC (Addiction Medicine), St. Paul’s Hospital Addiction Medicine Division
            \n<\/strong>Vancouver, BC<\/p>\n

            Tacie McNeil, Clinical Nurse Educator, Recovery Alberta
            \n<\/strong>Calgary, AB<\/p>\n

            Karine Meador, MD, CCFP(AM)
            \n<\/strong>Edmonton, AB<\/p>\n

            Liam Michaud, Researcher, York University
            \n<\/strong>Toronto, ON<\/p>\n

            Troy Mitchell, Doctor, Recovery Alberta
            \n<\/strong>Calgary, AB<\/p>\n

            Alanna Morgan, MD, CCFP
            \n<\/strong>Thunder Bay, ON<\/p>\n

            Jacqueline Myers, HIV\/Addictions Medicine Pharmacist
            \n<\/strong>Regina, SK<\/p>\n

            Jennifer Ng, Addiction Medicine Specialist, Family Physician, Centre for Addiction and Mental Health (CAMH), Unity Health Toronto
            \n<\/strong>Toronto, ON<\/p>\n

            Seonaid Nolan, Physician
            \n<\/strong>Vancouver, BC<\/p>\n

            Aulora Oleynick, Family Physician
            \n<\/strong>Edmonton, AB<\/p>\n

            Asha Olmstead, FRCPC, MD, Providence Health Services
            \n<\/strong>Vancouver, BC<\/p>\n

            Emily Ower, Family Physician and Perinatal Addictions Medicine, Vancouver Coastal Health
            \n<\/strong>Vancouver, BC<\/p>\n

            Laura Pace, Nurse Practitioner, Reach Niagara
            \n<\/strong>St. Catharines, ON<\/p>\n

            Vanessa Paquette, Clinical Pharmacy Specialist, BC Women\u2019s Hospital
            \n<\/strong>Vancouver, BC<\/p>\n

            Lynn Christine Parker, Nurse Practitioner, Red Deer Opioid Dependency Program
            \n<\/strong>Red Deer, AB<\/p>\n

            Judi<\/strong> Parrott, Pharmacist
            \n<\/strong>Calgary, AB<\/p>\n

            Andrew Patterson, Addiction Medicine Physician, Canadian Addiction Treatment Centres
            \n<\/strong>Ottawa, ON<\/p>\n

            Steven Persaud, MD
            \n<\/strong>Calgary, AB<\/p>\n

            Todd Peterson, Physician, Addiction Medicine
            \n<\/strong>Calgary, AB<\/p>\n

            Brianna Olson Pitawanakwat, Harm Reductionist and Social Worker, Toronto Indigenous Harm Reduction
            \n<\/strong>Toronto, ON<\/p>\n

            Preeti Popuri, MD, Brantford RAAM
            \n<\/strong>Brantford, ON<\/p>\n

            Elma Raissi, MD, Recovery Alberta
            \n<\/strong>Calgary, AB<\/p>\n

            Rebecca Rich, Physician, MD, MSc, FRCSC, University of Alberta
            \n<\/strong>Edmonton, AB<\/p>\n

            Genevieve Rochon-Terry, MD, CFPC, Unity Health Toronto, University of Toronto
            \n<\/strong>Toronto, ON<\/p>\n

            Cayley Russell, Researcher, Centre for Addiction and Mental Health (CAMH)
            \n<\/strong>Toronto, ON<\/p>\n

            Andrea Ryan, MD, Medical Director Addiction Medicine, Providence Health Care
            \n<\/strong>Vancouver, BC<\/p>\n

            Ginetta Salvalaggio, MD, MSc, CCFP(AM)
            \n<\/strong>Edmonton, AB<\/p>\n

            Oded Samuel, MD
            \n<\/strong>Toronto, ON<\/p>\n

            Amanda Sauv\u00e9, MD, Family Medicine – Focused Practice Addiction Medicine, Arrow Medical Clinic
            \n<\/strong>Barrie, ON<\/p>\n

            Clark Schommer, MD
            \n<\/strong>Calgary, AB<\/p>\n

            Mark Scott, MD, CCFP(EM), ISAM, Recovery Alberta
            \n<\/strong>Calgary, AB<\/p>\n

            Suzanne Shoush, Physician, University of Toronto
            \n<\/strong>Toronto, ON<\/p>\n

            Tannis Spencer, MD, CCFP (AM)
            \n<\/strong>Edmonton, AB<\/p>\n

            Leah Steele, MD, PhD, CCFP, Assistant Professor, Department of Family and Community Medicine, University of Toronto
            \n<\/strong>Toronto, ON<\/p>\n

            Ceire Storey, MD BC Centre on Substance Use
            \n<\/strong>Vancouver, BC<\/p>\n

            Cole Sugden, Addiction Medicine Physician, St. Paul\u2019s Hospital, Vancouver Coastal Health, BCCSU
            \n<\/strong>Vancouver, BC<\/p>\n

            Janelle Syring, Family Doctor
            \n<\/strong>Calgary, AB<\/p>\n

            Carolyn Travers, Family and Addictions Doctor, RAAM Clinic, Wellness and Recovery Centre
            \n<\/strong>Owen Sound, ON<\/p>\n

            Kerri Treherne, Family Doctor
            \n<\/strong>Calgary, AB<\/p>\n

            Suzanne Turner, MD, MBS, CCFP(AM), DABAM, Associate Clinic Professor, Family Medicine, McMaster University; Head of Service, Substance Use Service, St. Joseph’s Healthcare Hamilton, Medical Lead, Program for Substance Use in Pregnancy, Maternity Centre of Hamilton
            \n<\/strong>Hamilton, ON<\/p>\n

            Emily van der Meulen, Professor, Department of Criminology, Toronto Metropolitan University
            \n<\/strong>Toronto, ON<\/p>\n

            Eden VanDevanter, MCDM, CCFP, McMaster Family Medicine
            \n<\/strong>Hamilton, ON<\/p>\n

            Nicole Veltri, Physician, Recovery Alberta
            \n<\/strong>Calgary, AB<\/p>\n

            Sharon Vipler, Physician, Program Medical Director, Fraser Health Authority Addiction Medicine and Substance Use Services
            \n<\/strong>Surrey, BC<\/p>\n

            Marysia Waraksa, Nurse Practitioner
            \n<\/strong>Toronto, ON<\/p>\n

            Nena-Rae Watson, Family and Addiction Medicine Physician, St Michael\u2019s Hospital, Toronto Western Hospital
            \n<\/strong>Toronto, ON<\/p>\n

            Sarah Weicker, MD, Addiction Medicine Physician, Providence Health
            \n<\/strong>Vancouver, BC<\/p>\n

            Edwin Wey, Social Worker, Mount Sinai Hospital
            \n<\/strong>Toronto, ON<\/p>\n

            Patty Wilson, NP-PHC, DN
            \n<\/strong>Calgary, AB<\/p>\n

            Andrew Wong, MD, FCFP, The Alex Community Health Centre
            \n<\/strong>Calgary, AB<\/p>\n

            Jennifer Wyman, MD, Women’s College Hospital, META:PHI
            \n<\/strong>Toronto, ON<\/p>\n

            Felicia Yang, Clinical Pharmacy Specialist, Providence Health Care
            \n<\/strong>Vancouver, BC<\/p>\n

            Samantha Young, MD, University of British Columbia
            \n<\/strong>Vancouver, BC<\/p>\n

            Melissa<\/strong> Yu, MD, MPH, CCFP(AM)
            \n<\/strong>Toronto, ON<\/p>\n

            Cristina Zaganelli, Nurse Practitioner
            \n<\/strong>Calgary, AB<\/p>\n

            Linda Zhang, MD, CCFP
            \n<\/strong>Vancouver, BC<\/p>\n

            Grace Zhu, Addiction Medicine Physician, Clinical Addictions Program, St Paul’s Hospital
            \n<\/strong>Richmond, BC<\/p>\n

            _____________________________________________________<\/p>\n

            [1]<\/sup><\/a> United Nations General Assembly, United Nations Standard Minimum Rules for the Treatment of Prisoners (the Nelson Mandela Rules) : resolution \/ adopted by the General Assembly<\/em>, A\/RES\/70\/175, 8 January 2016, available at www.refworld.org\/legal\/resolution\/unga\/2016\/en\/119111<\/a>.<\/p>\n

            [2]<\/sup><\/a> I. Yakovenko et al., \u201cManagement of opioid use disorder: 2024 update to the national clinical practice guideline,\u201d CMAJ <\/em>(2024) 196:E1280-90.<\/p>\n

            [3]<\/sup><\/a> See I. Yakovenko et al., ibid;\u00a0 American Society of Addiction Medicine, National Practice Guideline for the Treatment of Opioid Use Disorder, <\/em>2020, available at www.asam.org\/quality-care\/clinical-guidelines\/national-practice-guideline<\/a>; M. Dematteis et al., \u201cRecommendations for buprenorphine and methadone therapy in opioid use disorder: a European consensus\u201d Expert Opin<\/em> Pharmacother<\/em> (2017) 18(18).<\/p>\n

            [4]<\/sup><\/a> College of Family Physicians of Canada, Position Statement on Access to Opioid Agonist Treatment in Detention<\/em>, November 2019, available at www.cfpc.ca\/CFPC\/media\/Images\/PDF\/201912-Position-Statement-Prison-Health-Opioid-Therapy.pdf<\/a>.<\/p>\n

            [5]<\/sup><\/a> Corrections and Conditional Release Act<\/em>, SC 1992, c 20, ss. 86-86.1.<\/p>\n

            [6]<\/sup><\/a> See, e.g.,\u00a0 R. Ivasiy et al., \u201cRetention and dropout from sublingual and extended-release buprenorphine treatment: A comparative analysis of data from nationally representative sample of commercially-insured people with opioid use disorder in the United States,\u201d Int J Drug Policy<\/em> (2025) 138:104748; A. Iacono et al., “Characteristics, treatment patterns and retention with extended-release subcutaneous buprenorphine for opioid use disorder: A population-based cohort study in Ontario, Canada,\u201d Drug Alcohol Depend<\/em> (2024) 254:111032; B. Nosyk et al, \u201cBuprenorphine\/Naloxone vs Methadone for the Treatment of Opioid Use Disorder,\u201d JAMA<\/em> (2024) 332:21; L. Degenhardt et al., \u201cBuprenorphine versus methadone for the treatment of opioid dependence: a systematic review and meta-analysis of randomised and observational studies,\u201d The Lancet<\/em> (2023) 10(5):386-402.<\/p>\n

            [7]<\/sup><\/a> See, e.g., C. Timko et al., \u201cRetention in Medication-Assisted Treatment for Opiate Dependence: A Systematic Review,\u201d J Addict Dis <\/em>(2109) 35(1).<\/p>\n

            [8]<\/sup><\/a> C. Russell et al., \u201cFeasibility and effectiveness of extended-release buprenorphine (XR-BUP) among correctional populations: a systematic review,\u201d Am J Drug Alcohol Abuse<\/em> (2024) 50(5):567-587; K. Lee et al., \u201cReal-world Evidence for Impact of Opioid Agonist Therapy on Nonfatal Overdose in Patients with Opioid Use Disorder during the COVID-19 Pandemic,\u201d Journal of Addiction Medicine <\/em>(2023) 17(6):374-381;\u00a0\u00a0\u00a0\u00a0\u00a0 A. O\u2019Connor et al, \u201cCommunity buprenorphine continuation post-release following extended release vs. sublingual buprenorphine during incarceration: a pilot project in Maine,\u201d Health & Justice<\/em> (2024) 12:28; J. Lee et al., \u201cComparison of Treatment Retention of Adults With Opioid Addiction Managed With Extended-Release Buprenorphine vs Daily Sublingual Buprenorphine-Naloxone at Time of Release from Jail,\u201d JAMA <\/em>(2021) 4(9).<\/p>\n

            [9]<\/sup><\/a> C. Russell et al., ibid.<\/p>\n

            [10]<\/sup><\/a>\u00a0 J. Lee et al., supra.<\/p>\n

            [11]<\/sup><\/a> A. Iacono et al., supra. See also The Ontario Drug Policy Research Network. [December 2025]. Evolving extended-release subcutaneous buprenorphine (BUP-ER; Sublocade\u00ae) treatment patterns in Ontario, 2021 to 2024. Available from:\u00a0https:\/\/odprn.ca\/research\/publications\/bup-er-treatment-patterns-in-ontario\/<\/a><\/p>\n

            [12]<\/sup><\/a> See, e.g., A. Mendell et al., “Utilization of Opioid Agonist Therapies in Canada<\/em>,\u201d CADTH <\/em>(2023) 3(8).<\/p>\n

            [13]<\/sup><\/a> See, e.g., Federal Trade Commission, Indivior, Inc. to Pay $10 Million to Consumers, Settling FTC Charges that the Company Illegally Maintained a Monopoly over the Opioid Addiction Treatment Suboxone, <\/em>24 July 2020, available at www.ftc.gov\/news-events\/news\/press-releases\/2020\/07\/indivior-inc-pay-10-million-consumers-settling-ftc-charges-company-illegally-maintained-monopoly<\/a>.<\/p>\n

            [14]<\/sup><\/a> See, e.g., Correctional Services Canada, 2024 to 2025 Departmental Plan<\/em>, 24 February 2025, available at www.canada.ca\/en\/correctional-service\/corporate\/transparency\/reporting\/departmental-plan\/2024-2025.html<\/a>.<\/p>\n

            [15]<\/sup><\/a> See, e.g., B. Fischer et al. \u201cThe burden of drug overdose deaths among correctional populations: implications for interventions,\u201d CMAJ<\/em> (2024) 196(43).","protected":false},"author":1,"featured_media":0,"menu_order":0,"template":"","meta":{"_acf_changed":false,"footnotes":""},"publication_topics":[145,147,155],"publication_type":[180],"publication_language":[184],"class_list":["post-25457","publication22","type-publication22","status-publish","hentry","publication_topics-access-to-medicines","publication_topics-drug-policy","publication_topics-prisons","publication_type-open-letter","publication_language-english"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.hivlegalnetwork.ca\/site\/wp-json\/wp\/v2\/publication22\/25457","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.hivlegalnetwork.ca\/site\/wp-json\/wp\/v2\/publication22"}],"about":[{"href":"https:\/\/www.hivlegalnetwork.ca\/site\/wp-json\/wp\/v2\/types\/publication22"}],"author":[{"embeddable":true,"href":"https:\/\/www.hivlegalnetwork.ca\/site\/wp-json\/wp\/v2\/users\/1"}],"version-history":[{"count":3,"href":"https:\/\/www.hivlegalnetwork.ca\/site\/wp-json\/wp\/v2\/publication22\/25457\/revisions"}],"predecessor-version":[{"id":25584,"href":"https:\/\/www.hivlegalnetwork.ca\/site\/wp-json\/wp\/v2\/publication22\/25457\/revisions\/25584"}],"wp:attachment":[{"href":"https:\/\/www.hivlegalnetwork.ca\/site\/wp-json\/wp\/v2\/media?parent=25457"}],"wp:term":[{"taxonomy":"publication_topics","embeddable":true,"href":"https:\/\/www.hivlegalnetwork.ca\/site\/wp-json\/wp\/v2\/publication_topics?post=25457"},{"taxonomy":"publication_type","embeddable":true,"href":"https:\/\/www.hivlegalnetwork.ca\/site\/wp-json\/wp\/v2\/publication_type?post=25457"},{"taxonomy":"publication_language","embeddable":true,"href":"https:\/\/www.hivlegalnetwork.ca\/site\/wp-json\/wp\/v2\/publication_language?post=25457"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}