Brad Bradford has it all wrong. Mandatory treatment won't solve the overdose crisis. Here's what will

Brad Bradford wants Toronto voters to believe that with mandatory addiction treatment, he will solve the problems of the overdose crisis, open public drug use and homelessness. He hopes the stern word 'mandatory' will appeal to those who are frustrated with visible drug use. Bradford is touting a simplistic approach to a complex problem. It won't solve Toronto's challenges around drug addiction. For thirteen years, I have cared for people who use drugs in Toronto. One of the prevailing tensions in my work is: every day, I see people making choices I disagree with and that harm their own health. I try to understand where those decisions come from and offer medical treatments that support better options. It is often frustrating, emotionally hard work. One might ask: 'Can't you just tell people to stop using drugs, and force them to do it?' My answer is: 'If only it were so simple.' The idea of mandatory treatment is not new. Despite having been tried, it is not well supported by the scientific literature. In the U.S., where it is sometimes called 'civil commitment', one study showed that a third of people relapsed on the same day of their release. A study in Sweden, where about a thousand persons per year are committed to compulsory care for up to six months, showed a very high risk of dying in the two weeks after discharge. A California study showed that, while mandated treatment increases the likelihood of treatment completion in the short term, it does not reduce relapse in the long term. A McMaster University review of 51 studies concluded that health outcomes are worse with involuntary compared to voluntary treatment, and points to concerns around violence and violation of human rights. In medicine we often weigh costs and benefits. The cost of implementing Bradford's blunt declaration, 'Toronto needs mandatory addiction treatment,' would be to compromise people's Charter rights, while the medical literature tells us not to expect much benefit, and that we may simply cause harm. What should be mandatory is that the combined levels of government should offer the full range of resources needed to help people who use drugs. While the evidence for mandated treatment is not good, the evidence for treatment of some addictions — such as opioids and alcohol, is strong. Despite Bradford's assertion that people need to wait 72 days to be seen in a HART hub, outpatient addiction medicine care is available in many clinics in Toronto on a same day basis without appointment. I know because I run a clinic that offers this level of access. Part of what Bradford objects to strongly, and rightfully so, is seeing our fellow citizens suffering on the street. He says, 'I can't hold my daughter's hand and step around a human being laying unconscious on the sidewalk and pretend that that's acceptable.' None of us should ignore the suffering in our city. To address this suffering, we should be clear on what is needed. While access to outpatient care has improved in the past decade, overnight stays in detoxification facilities are harder to get. They are chronically full. People are told to call back every day. Private residential drug treatment facilities can often accommodate private-paying patients within weeks while they have waiting lists of months for publicly funded spots. The barrier is the funding, not the facilities. Bradford says we need to 'commit to at least 100 recovery house beds in Toronto.' This number seems unrelated to the actual scope of the problem. The City of Toronto's 2025 Point-in Time Count of People Experiencing Homelessness concluded that on Oct. 22, 2025, 12,196 people were experiencing homelessness. Of those, 7 per cent, or 853 people self-identified 'substance use issue' as the reason for housing loss. So, there are 8.5 times the number of people who need housing due to a 'substance use issue' as there are proposed recovery house beds in Bradford's plan. Housing is something people need for the duration of their lives, not the duration of a drug-treatment program. In our wealthy city, shelters are so full that people sleep on TTC buses or outside in the winter. They are not sleeping in the parks to inconvenience park-goers. They have nowhere else to go. Getting affordable housing in Toronto can mean waiting for years. While unhoused, it is impossible to attend school or work and a person becomes more deeply alienated from the rest of society. Soon, some people's social circles are composed entirely of unhoused persons who use drugs. No one says this is what they want. People tell me they want a 'normal' life, but some people can't find a way to get there. It should be 'mandatory' that we offer accessible pathways off the street. People will take them. Meanwhile, by focusing his objections on encampments and visible drug use, Bradford seems unaware that many people with addictions are housed, working, and in need of support. An Ontario study has found that the rates of opioid toxicity deaths are highest amongst construction and trade workers. Just as it's not acceptable to overdose on the street, it's not acceptable for people to overdose and die alone in their own home where there was no one to help them. One measure to mitigate the risk of overdose for both the housed and unhoused was supervised consumption sites, almost all of which the Doug Ford government has recently closed. If we care about people who use drugs, both housed and unhoused, we should be calling on the province to reinstate supervised consumption sites, and build robust pathways from harm reduction to treatment. The larger problem of unhoused persons is housing itself. Mayors and the provinces need to tackle deeply affordable housing, but to move the needle on this issue they will have to bring the federal government on board. Only 3.5 per cent of our overall housing stock is community housing, which is half of the OECD average. Build Canada Homes needs to have specific targets devoted to deeply affordable housing if we are going to address the encampment issue. The landmark $110 million Canadian study, 'At Home/Chez Soi' project provided immediate access to independent rental housing without preconditions such as sobriety or treatment adherence. This was effective at helping participants maintain housing stability. We know this worked. Let's give people housing without twisting their arms that they must accept treatment. In my thirteen years in addiction medicine, I have learned that 'forcing' people to change doesn't work. What works is building partnership, believing that people can change their lives, and offering the broader structures — including evidence-based medical treatment, housing, community supports, education, employment, within which people can make healthy choices. Although no one chooses addiction, the recovery from addiction involves learning to make better choices. We are not going to solve this problem by making treatment mandatory.