Drug toxicity is one of the leading causes of deaths in prisons in Canada, with overdose deaths rising significantly over the past decade due to toxic drug supply.
More than 50 per cent of people in prison are estimated to be affected by problematic substance use — yet prison authorities across the country are increasingly restricting access to a key, evidence-based treatment option, resulting in a dramatic drop in people receiving this care.
Opioid Agonist Treatment (OAT) is a medication used to treat opioid use disorder. It provides a stable, regulated dose that aims to prevent withdrawal and reduce cravings. Decades of research have shown that people receiving OAT experience substantially lower rates of fatal drug toxicity and other health complications.
But for it to properly work, OAT must be low barrier, compassionate and individualized. In general, methadone, buprenorphine/naloxone (Suboxone) and injectable buprenorphine (Sublocade) are all considered first-line OAT options. They are not interchangeable. Abrupt discontinuation increases the risk of overdose, and changes in treatment require careful clinical oversight to avoid destabilization and other harms.
Yet, in April 2026, Correctional Services Canada (CSC), the institution responsible for federal prisons across the country, finalized the implementation of a policy designating Sublocade (delivered by injection) as the preferred first-line treatment, while making Suboxone (delivered orally) only accessible by special request.
Despite a six-month transition period intended to support individualized care, reports from people in custody suggested a different reality: rapid, and in many cases coercive and painful, transitions from Suboxone to Sublocade despite a long period of stability on Suboxone, aversion to injections, or other preferences. People have also been pressured to move off methadone. Some have discontinued treatment altogether.
In Alberta, where a switch to Sublocade was also adopted, doctors are similarly receiving daily reports of patients in provincial institutions being abruptly cut off from other OAT options and switched to Sublocade, resulting in painful withdrawal and extreme distress.
In British Columbia, healthcare providers have raised alarms about a correctional initiative that reportedly offers financial incentives to incarcerated people who agree to receive Sublocade injections, despite unclear ethical oversight and concerns about coercive prescribing practices. Critics warn that paying people in prison to accept one specific medication restricts access to other first-line OAT options, undermines patient choice and raises serious questions about informed consent and healthcare independence in correctional settings.
The issue is not whether Sublocade is effective: for some patients, it is. The concern is whether restricting access to other first-line options aligns with established standards of care. Hundreds of clinicians and researchers have publicly stated that it does not.
CSC’s own data points to a troubling trend. In January 2025, 3,447 people were enrolled in OAT across federal prisons. By March 2026, that number had declined to 2,565 — a drop of nearly 900. This drop began in the months following the October 2025 policy shift toward Sublocade.
Temporal alignment does not, on its own, prove causation. But in a setting where the risk of fatal drug toxicity is well-documented, a sustained and alarming decline in engagement with evidence-based treatment warrants scrutiny.
Access to OAT in federal prisons has already been the subject of a human rights complaint, compelling CSC to better meet professional standards, including ensuring that individuals can access the treatment that works best for them.
The current decline in patients on OAT raises the question of whether that commitment is being maintained.
Correctional healthcare must meet professional standards. When multiple first-line treatments are recognized and individualized care is recommended in evidence-based, expert driven guidelines, narrowing access to treatment options must be challenged. In a system that operates largely outside public view — and where people cannot choose their providers, pharmacies, or treatment settings — institutional decisions about healthcare demand transparency and accountability.
