Ontario addiction specialists are calling for stricter regulations on the prescribing of "safer supply" drugs. This practice allows individuals with substance use disorders to receive free opioids, such as hydromorphone, with minimal oversight. Experts warn that some doctors are exploiting this system by operating "electronic pill mills"—video terminals where patients can obtain large prescriptions after brief remote consultations.

"Safer supply" was introduced as a harm reduction strategy in the late 2010s and early 2020s, supported by the federal Liberals and British Columbia's NDP. However, reports revealed that many recipients were selling their prescribed hydromorphone to buy illicit street fentanyl, exacerbating addiction issues in communities. Earlier this year, the federal government defunded its safer supply pilot programs, but most Canadian doctors can still prescribe these drugs off-label due to provincial jurisdiction.

While Alberta effectively banned safer supply prescribing in 2022, British Columbia has implemented regulations requiring that all doses be consumed under medical supervision. In contrast, Ontario's approach remains largely unregulated. In British Columbia, guidelines limit patients to 14 eight-milligram hydromorphone pills per day. However, some Ontario doctors report that their colleagues prescribe 30 to 40 pills daily, with some patients receiving even more. For context, just two or three of these pills can lead to an overdose in someone not accustomed to opioids.

Many addiction specialists in Ontario have noted that the availability of safer supply has diminished the demand for traditional addiction treatments, such as methadone and Suboxone. Patients often prefer the free opioids over pursuing recovery options. As a result, some methadone providers have shifted to offering safer supply to maintain their operations and increase profits.

Dr. Lori Regenstreif, an addiction physician based in Hamilton, expressed concern about the rise of tele-prescribed safer supply. She described a system where addiction specialists set up video booths in pharmacies, allowing patients to receive large opioid prescriptions after only a few minutes of consultation. "You’ve basically got a doctor anywhere in the province telling a pharmacy somewhere else in the province to, go ahead, give this person (hydromorphone) tablets," she said.

Regenstreif highlighted the risks associated with this model, noting that one physician she knows spends their days writing high-risk opioid prescriptions for patients across the province with minimal interaction. This setup has become financially lucrative for doctors and investors who own these video booths, as they can increase their billings by seeing a high volume of patients while minimizing overhead costs.

Pharmacies also benefit, as they can earn significant dispensing fees from patients who need to pick up multiple prescriptions daily. Regenstreif criticized this approach, stating that there is "no way" patients are receiving adequate care under such a "predatory" form of telemedicine. She emphasized that responsible addiction medicine requires regular physical examinations and attention to the psychosocial aspects of recovery, which is not feasible with such limited patient interaction.