The Toronto Drug Strategy (TDS) is a comprehensive drug strategy for the City of Toronto based on four integrated parts – prevention, harm reduction, treatment and enforcement. All four parts are needed to effectively reduce the harms of alcohol and other drug use.
The current focus of the Toronto Drug Strategy is the implementation of the Toronto Overdose Action Plan, which provides a comprehensive set of actions to prevent and respond to overdoses. The Plan combines the knowledge and expertise of people who use drugs, their family and friends, and people working in the field with best practices.
Toronto Public Health worked with community partners to develop the Toronto Overdose Action Plan: Prevention & Response, which was endorsed by the Board of Health on March 20, 2017. This includes a comprehensive set of actions for all orders of government to prevent and respond to drug overdoses:
The Toronto Overdose Action Plan was updated in 2019 based on broad community input. This update, which is a supplement to the original Toronto Overdose Action Plan, was endorsed by the Board of Health and City Council in June 2019:
On February 25, 2019, the Board of Health endorsed the Toronto Indigenous Overdose Strategy (TIOS). This strategy was developed by an Indigenous facilitator and is grounded in the input of Indigenous People who use/used drugs, and service providers that work with Indigenous People who use drugs. The recommendations reflect key actions needed in the areas of prevention, harm reduction and treatment. Toronto Public Health (TPH) is supporting implementation of the strategy, and will undertake the actions directed to TPH. Toronto Public Health will also support implementation of the TIOS in collaboration with Indigenous service providers and community members, including Indigenous People who use/have used substances, and other City divisions.
A public health approach to drug use.
Although people from all demographic and socioeconomic groups use substances, criminal penalties for the possession of drugs for personal use create barriers for people to access a range of health and social supports. The challenge is intensified because criminalization also leads to stigma and discrimination against people who use drugs. The harms of criminal justice-based drug policies have disproportionately impacted Black and Indigenous people and other marginalized groups, worsening health and social inequities. By removing the harms of criminalization, the goal of decriminalization is to increase health equity and reduce physical, mental, and social harms for all people in Toronto.
In 2018, Toronto Public Health reviewed the evidence and conducted a community dialogue process to explore how to change the approach to drugs, and what a public health approach to drugs could look like in Canada.
In Canada, the federal government, through the Controlled Drugs and Substances Act (CDSA), provides the current legal framework for drugs. The City of Toronto and the Province of Ontario do not have the authority to make or change the legal approach to drugs.
The Toronto Board of Health endorsed the use of a public health approach in developing alternative models to the criminalization of personal drug use in July 2018. At this time, the Board of Health called on the federal government to decriminalize the possession of all drugs for personal use and scale up prevention, harm reduction, and treatment services.
The federal Minister of Health has the authority under the Controlled Drugs and Substances Act to grant an exemption to the Controlled Drugs and Substances Act and allow the possession of drugs for personal use. At the Board of Health meetings in June 2020 and November 2020, the Board called on the Federal Minister of Health to decriminalize the simple possession of all drugs and scale up prevention, harm reduction, and treatment services.
At the Board of Health meeting on June 14, 2021, the Board asked Toronto Public Health staff to convene a multi-sectoral working group to provide advice on developing a health and social equity-based alternative approach to drug criminalization, as a step towards requesting an exemption under the Controlled Drugs and Substances Act.
On December 6, 2021, the Toronto Board of Health considered Item HL32.3, Actions to Respond to the Drug Poisoning Crisis in Toronto, and directed the Medical Officer of Health to submit a request to Health Canada by the end of 2021 for an exemption under Section 56(1) of the Controlled Drugs and Substances Act. This request would start a process to decriminalize the personal possession of illicit substances within the City of Toronto’s boundaries.
On June 20, 2022, the Board of Health directed the Medical Officer of Health to continue working with Health Canada on the conditions that would allow for an exemption approval under Section 56(1) of the Controlled Drugs and Substances Act within the City of Toronto.
The made-in-Toronto model of decriminalization is a public health response to the drug toxicity crisis that recognizes the importance of human rights and the social determinants of health. It has been informed by a diverse range of stakeholders.
A preliminary request to Health Canada was submitted on January 4, 2022 for an exemption to the Controlled Drugs and Substances Act to allow for the possession of drugs for personal use in Toronto.
View Initial Submission to Health Canada [button:
Since the initial submission, Toronto Public Health has spent more than a year convening experts and engaging community members, including people with lived and living experience of drug use, first responders, frontline harm reduction workers, and community service providers to develop a made-in-Toronto model of decriminalization.
The proposed Toronto model enhances public health and public safety considerations and advances equity for those most impacted by the harms of criminalization.
Components of updated submission:
Toronto Public Health continues to work with Health Canada on the exemption request and a range of implementation considerations toward the goal of the exemption being granted.
Toronto Public Health encourages anyone with comments about Toronto’s model of decriminalizing drugs for personal use to contact email@example.com. All feedback received is read and thoroughly considered.
The process to develop an alternative model was designed to centre people with lived and living experiences of drug use, including people who are most impacted by current drug laws, and the agencies and service providers that support them through roundtable discussions, interviews, and diverse working groups.
Toronto Public Health convened a multi-sectoral decriminalization reference group to provide input into the development of an alternative model to criminalization in Toronto. Toronto Public Health also convened multiple working groups to inform the details of a made-in-Toronto model, including a Quantities Working Group, Health and Social Supports Working Group, African, Caribbean & Black Working Group and an Indigenous-Led and Delivered Pathway Working Group. More information is available in the Toronto Exemption Request FAQ.
Members of the working group were not asked to endorse the group’s work or the Medical Officer of Health’s request to Health Canada. Participation did not imply support or agreement with either the working group’s advice or the request to Health Canada.
The decriminalization reference group was chaired by Dr. Eileen de Villa, the Medical Officer of Health for Toronto, and there were approximately 25 organizations represented:
A public health approach to drugs shifts addressing substance use away from the criminal justice system. A public health approach enhances policies and laws that prevent, reduce and respond to the potential health harms associated with substances, while promoting overall well-being and respecting human rights. Principles of a public health approach to drugs include evidence-informed policy and practice, a commitment to social justice and human rights, and addressing the social determinants of health while ensuring public safety. Strategies include health promotion and protection, prevention, harm reduction and treatment.
Decriminalization is the removal of the criminal offence for the possession of drugs for personal use.
There are many models of decriminalization used in other jurisdictions (e.g., models that use administrative penalties, fines, or involuntary treatment to replace criminalization).
Toronto’s model of decriminalization does not replace criminalization with any alternative penalties.
If approved by Health Canada, decriminalization would mean that s. 4(1) of the Controlled Drugs and Substances Act related to the possession of drugs for personal use would not apply to persons in Toronto. People could no longer be arrested or charged for personal possession of drugs under the Controlled Drugs and Substances Act, subject to certain limitations.
Controlled drugs and substances are regulated under the Controlled Drugs and Substances Act. This includes a range of substances from illicit drugs to prescription medications, such as cocaine, opioids, benzodiazepines, morphine, and methamphetamine, among others.
The proposed model of decriminalization would apply to all unregulated drugs listed in the Controlled Drugs and Substances Act. Toronto Public Health’s Decriminalization Working Group, and consultations with additional experts and people with lived and living experience provided advice that Toronto’s model should apply to all drugs and substances listed in the Controlled Drugs and Substances Act. This approach would account for varying drug use patterns and the unpredictability of the toxic and contaminated supply, especially for those individuals who are most vulnerable to the harms of criminalization.
Decriminalization is not the same as legalization. Under the proposed Toronto model of decriminalization, criminal offences for the possession of drugs for personal use would no longer apply. Certain activities such as trafficking and the production of drugs will remain illegal.
Decriminalization does not mean that substances will be produced and legally available for purchase and regulated like alcohol, tobacco or cannabis.
Decriminalization does not address the contamination of drugs in the unregulated market and therefore will be accompanied by improved access to services, such as supervised consumption services, safer supply and treatment to address the drug toxicity crisis.
All activities associated with drug trafficking, exporting and production, including possession of drugs for those purposes, would remain illegal and subject to existing criminal penalties.
Decriminalization would eliminate personal drug possession charges and arrests for people who use drugs in Toronto. This will reduce the harmful impacts of criminal justice involvement on people’s lives, including the negative impacts of having a criminal record when trying to obtain housing and employment.
Decriminalization will also reduce the stigma against people who use drugs, and remove barriers to accessing health and social services. Reducing stigma will likely have the greatest positive impact on public health and public safety and that is why establishing a robust continuum of care is one of the important components of this plan.
Decades of stigma related to drug use has led to an assumption that decriminalization might have a negative impact on community safety. However, possessing drugs for personal use does not directly cause harm to others. The proposed Toronto model reflects a balance of public health and public safety considerations, advances equity for those most impacted by the harms of criminalization, and is fully endorsed by Toronto Public Health and the Toronto Police Service. Within the model, the Toronto Police Service maintains the other legal tools they need to ensure community safety for everyone in the city.
There are different models of decriminalization used around the world applied to some or all drugs. Examples of places that have implemented some form of drug decriminalization include Portugal, Czech Republic, Colombia, Argentina, Germany, Spain, Netherlands, Uruguay, some jurisdictions in the United States (e.g. Oregon), and British Columbia.
Countries and jurisdictions that have decriminalized the possession of drugs for personal use and invested in public health interventions have seen positive results, including reductions in drug use among certain populations, increase in the number of people accessing treatment, decreases in HIV transmission and drug-related deaths, financial savings to the criminal justice system, and improved community relationships.
Available evidence on the impact of decriminalization on drug use patterns is mixed. A systematic review of evaluations of decriminalization and legalization in other jurisdictions published in 2020 found that in the majority of jurisdictions that implemented decriminalization or legalization, drug use trends did not change and drug use did not increase.5 Other evidence shows that decriminalization does not significantly increase drug use. Following decriminalization, Portugal reported small increases in drug use among adults, but also reductions in problematic use and drug use among adolescents.
In addition to specific referral options for youth, Toronto Public Health will continue to work with schools and children’s mental health and addictions service providers to offer a wide range of substance use education and programming, including substance use prevention, delaying the onset of drug use, and harm reduction.
Toronto is a diverse city with its own local context around substance use, including the types of drugs used, patterns of use, and purchasing patterns. The proposed model of decriminalization was informed by extensive consultations reflecting Toronto’s local context and aims to have the largest impact in eliminating the harms associated with criminalization for the most people. Prior to the implementation of the proposed Toronto model, Toronto Public Health and the Toronto Police Service will be visiting key jurisdictions in British Columbia to ensure that we benefit from the lessons learned in that jurisdiction with a view to ensuring effective implementation.
Toronto Public Health convened a reference group and a number of working groups to help inform the details of the Toronto model. Membership included a diverse range of partners such as people with lived and living experience of drug use, community organizations, academic researchers, service providers, harm reduction workers, first responders, Indigenous and African, Caribbean and Black community members. Toronto Public Health also conducted a number of roundtables and a community survey with approximately 6,000 responses to gather input.
First responders will provide people with a referral card with information about organizations that will help make connections to a range of voluntary health and social supports. There will be a range of supports available, including harm reduction services and treatment options.
Specific referral supports for youth will be available through partners like the Youth Wellness Hubs to ensure that youth and their families receive connections to youth-specific services as an alternative to criminalization.
Toronto Public Health will continue to work with Indigenous partners to support Indigenous-led referral supports, and seek additional funding for Indigenous-specific harm reduction and healthcare services.
Toronto Public Health will also continue to call on federal and provincial government partners for additional funding for a range of mental health and substance use services to improve the health and well-being of everyone living in the city.
A full continuum of health and social services is needed to adequately meet the diverse needs of people who use drugs. Toronto Public Health’s Decriminalization Reference Group and the Health and Social Supports Working Group identified critical supports and services needed to ensure a successful implementation of decriminalization in Toronto. These included immediate and long-term housing and shelter, post-incarceration reintegration supports, peer supports and programs, and evidence-based treatment and harm reduction services, including mental health and substance use services leveraging a range of medical, non-medical, and harm-reduction interventions. There is also a need to expand access to culturally safe services for Indigenous and African, Caribbean and Black communities.
Additional investment from all orders of government will be needed to enhance, expand and integrate services in the city.
Toronto Police Service data demonstrates that charges for possession for personal use have declined since 2019. Data from the Toronto Police Service indicates that in 2021 there were 617 charges laid for possession under s. 4(1) of the Controlled Drugs and Substances Act. In 36 of these cases, possession was the only charge. In 581 of these cases, a possession charge was in addition to other Controlled Drugs and Substances Act charges.
Toronto Public Health supports and advocates for a national approach to decriminalization. At this time, Toronto Public Health is utilizing the tools currently available at the municipal level to address the harms of criminalization and advance a public health approach to drugs aimed at improving the health and well-being of people in the city.
The Toronto Public Health Decriminalization Working Group and Quantities Working Group reviewed and analysed four potential models of decriminalization against a co-developed set of principles. The four models considered were:
If approved by Health Canada, decriminalization would not impact past charges for possession under the Controlled Drugs and Substances Act.
In November 2022, Bill C-5 was put forward by the federal government and made amendments to the Criminal Code and the Controlled Drugs and Substances Acts. Amendments included automatic sequestration of past criminal records for simple possession within a two year period. This means that past and future criminal records for simple possession will be sealed and kept separate from other criminal records.
In April 2023, the Board of Health asked the Medical Officer of Health to create a comprehensive Mental Health and Addictions Strategy for Toronto, including an updated Toronto Drug Strategy.
This comprehensive strategy will offer recommendations for work across City of Toronto divisions, Toronto Public Health, local organizations and government partners.
Over the last year, Toronto Public Health has been consulting with partners in the substance use sector, including people who use drugs, key stakeholders in the mental health sector, and people with lived and living experience, to develop this strategy.
If you would like to share your views on how mental health and substance use policy and programming can be improved in the City, please contact firstname.lastname@example.org.