In Defense of Failed Policy: A Call for Iteration, Not Ideological Retreat

To the Editor, Canada continues to face a devastating overdose crisis, with roughly 19 to 22 deaths every day.1 Across provinces, these losses play out differently, shaped by geography, health-system capacity, and local politics. In response, governments have tried decriminalization, safer supply, new treatment models, and youth-focused services, often channeled through the federal Substance Use and Addictions Program (SUAP). SUAP now supports hundreds of projects across prevention, harm reduction, treatment, and system change. Together, these initiatives are building a more nuanced evidence base. A SUAP-funded qualitative study in Ottawa described reductions in illicit fentanyl use and injection frequency, along with better self-reported health, while also noting dose limits and concerns about diversion.2 Cohort data from Ontario linked safer opioid supply enrollment to fewer emergency department visits, fewer hospitalizations, and lower healthcare costs.3 Local evaluations in London and in Toronto’s Parkdale neighborhood show reduced reliance on the toxic supply, more secure housing, and improved mental health.4–6 National implementation research has documented staff strain, neighborhood tensions, regulatory uncertainty, and the fragility of short-term funding.7 These findings capture the tension at the heart of SUAP-funded innovation. Programs that appear to improve individual outcomes may also coincide with disruption in surrounding communities. Business owners and residents in some areas report increased visible street use, theft, and concern about diverted medications. These experiences should inform policy design, not be used to justify shutting programs down. They point to the need for clearer accountability and stronger connections with housing, primary care, and mental health supports. This is where Canadian addiction policy has often faltered. Over the past decade, governments have advanced policies faster than evidence could support. Predictable harms emerged, largely because prospective evaluation was not built in. Sound policy requires steady attention to data, early testing, and meaningful engagement with clinicians and communities. At its best, SUAP’s pilot structure allows for this kind of deliberate, iterative learning. A similar approach is warranted as provinces explore involuntary treatment. Alberta’s legislative framework and proposals emerging in British Columbia respond to difficult clinical realities.8,9 Both raise ethical, financial, and practical concerns. Evaluating these approaches before broad implementation will help clarify who benefits, who is placed at risk, and what trade-offs are involved. In a crisis this entrenched, the greater failure is refusing to learn. SUAP and related programs are unlikely to produce neat wins, but they can lead to clearer questions, better data, and more grounded policy—if imperfect results are used to guide, rather than shut down, future decisions.