A Mental Health, Substance Use, Harm Reduction & Treatment Strategy for Toronto

Our Health, Our City: A Mental Health, Substance Use, Harm Reduction and Treatment Strategy for Toronto is a comprehensive strategy to reduce substance use related harms and promote mental health and wellbeing. This is a strategy to strengthen and protect the mental health, wellbeing and safety of all Torontonians.

Mental health experiences occur on a spectrum, and many Torontonians experience mental health challenges. Recent data demonstrates concerning trends in various mental health outcomes, including anxiety, depression, burnout, loneliness and addictions.

Similarly, substance use occurs on a spectrum, and many Torontonians use substances, including alcohol, cannabis, nicotine/tobacco, as well as unregulated/illegal substances. While most substance use does not cause problems, substance use related health and social harms do occur. Toronto is also facing a devastating drug toxicity crisis. Between 2015 and 2022, close to 2,900 people died of opioid-related toxicity in the city – all deaths that were preventable.

This strategy is for all of Toronto — every age group, population and neighbourhood, and even those who may not have personal experience with mental health and/or substance use challenges.

Toronto is a diverse and resilient city that prioritizes the mental health, wellbeing and safety of all residents.

Our Health, Our City envisions a Toronto where:

  • Everyone can access the health care, services, resources and community spaces they need to support their mental health and prevent substance use related harms with dignity and ease.
  • Mental health and substance use are addressed as health issues rather than criminal issues.
  • Mental health and substance use stigma and discrimination have been eliminated.


Our Health, Our City’s mission is to advance policies, programs and partnerships in the City of Toronto that reduce inequities and increase access to the social determinants of health to improve mental health and wellbeing and reduce the health and social impacts of substance use related harms.


The following principles are the framework for Our Health, Our City:

  • Health and community safety for everyone
  • Meaningful inclusion of people with lived and living experience
  • Anti-oppression, anti-racism and decolonization
  • Evidence, innovation and continuous improvement
  • City-wide, collaborative, and comprehensive

Our Health, Our City offers a range of recommended actions across seven strategic goals for City of Toronto Divisions, Agencies, Corporations, and Boards, as well as government partners, health care leaders, schools, businesses, civil society and all Torontonians:

  1. Promote mental health and wellbeing across the lifespan.
  2. Prevent and reduce the harms and deaths related to substance use across the lifespan.
  3. Expand access to the full continuum of high-quality, evidence-based and client-centred services to address mental health and/or substance use issues, including harm reduction and treatment supports.
  4. Advance community safety and wellbeing for everyone.
  5. Improve access to housing and other social determinants of health.
  6. Support mentally healthy workplaces and optimize the mental health of workers.
  7. Proactively identify and respond to emerging mental health and substance use issues.

Our Health, Our City was developed through extensive engagement that centered the lived and living experiences of people with mental health issues and/or who use drugs, and included experts, community leaders, frontline staff from the mental health, harm reduction and addictions treatment sectors, and staff from many divisions of the City of Toronto.

Consultations, community engagements and research conducted:

  • 200 participants in 18 community roundtables which included people with lived and living experiences
  • 84 external stakeholder interviews
  • 30 interviews and roundtables with people who use drugs
  • 13 City Divisions, Commissions and Corporations consulted
  • Deputy Mayor’s Mental Health Roundtable in June 2023
  • Jurisdictional scan of mental health and substance use strategies
  • Reference group to provide input on the development of the strategy and its recommendations


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.

City of Toronto exemption request

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.

Initial submission

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.

Updated submission

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.

Next steps

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 drugstrategy@toronto.ca. All feedback received is read and thoroughly considered.

Process to develop an alternative model to criminalization

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.

Working groups

Toronto Public Health convened a multi-sectoral decriminalization reference group and working groups to provide input into the development of an alternative model to criminalization in Toronto.

The 2005 Toronto Drug Strategy (TDS) was a comprehensive drug strategy for the City of Toronto based on four integrated parts – prevention, harm reduction, treatment and enforcement.

The Toronto Overdose Action Plan: Prevention & Response was endorsed by the Board of Health on March 20, 2017. It included 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 was a supplement to the original Toronto Overdose Action Plan, was endorsed by the Board of Health and City Council in June 2019:

The Toronto Indigenous Overdose Strategy was developed by an Indigenous facilitator and grounded in the input of Indigenous People who use/used drugs, and service providers that work with Indigenous People who use drugs.

Mental Health — “The capacity of each and all of us to feel, think, and act in ways that enhance our ability to enjoy life and deal with the challenges we face. It is a positive sense of emotional and spiritual wellbeing that respects the importance of culture, equity, social justice, interconnections and personal dignity.” (Public Health Agency of Canada)
Learn more about mental health.

Substance use — “People use substances, such as controlled and illegal drugs, cannabis, tobacco/nicotine, and alcohol, for different reasons, including medical purposes; religious or ceremonial purposes; personal enjoyment; or to cope with stress, trauma or pain. Substance use is different for everyone and can be viewed on a spectrum with varying stages of benefits and harms.” (Health Canada)
Learn more about substance use.

Social Determinants of Health — The primary factors that affect our health are not health care services or treatments or even our lifestyle choices, rather, our health is shaped by the social determinants of health, which are the living conditions that we experience. Our access – or lack of access – to the social determinants of health have an impact on our mental health and well-being and influence our patterns of substance use. “…Our health is shaped by how income and wealth is distributed, whether or not we are employed and if so, the working conditions we experience. Our health is also determined by the health and social services we receive, and our ability to obtain quality education, food, and housing, among other factors. And contrary to the assumption that Canadians have personal control over these factors, in most cases these living conditions are imposed upon us by the quality of the communities, housing situations, work settings, health and social service agencies, and educational institutions with which we interact.” (The Social Determinants of Health: The Canadian Facts)