What You Need to Know
Ontario has one of the highest rates of substance use-related harms in Canada, yet the treatment system is fragmented and difficult for people to navigate. To better understand the residential treatment options available, researchers analyzed information in a database of all publicly-funded residential treatment programs. They found that there was limited information publicly available about the program details (including whether they offered opioid agonist treatment initiation or maintenance), wait times and fees. There were substantial differences among residential treatment programs across the province and a lack of standardization across programs.
What Is This Research About?
Ontario has one of the highest rates of substance use-related harm in Canada. Residential treatment programs provide in-house treatment for people with substance use disorders. Despite the need for these services, the treatment system is fragmented and difficult to navigate. This makes it challenging for people to know what treatment options are available and which would work best for them.
To better understand the current residential treatment options in Ontario, researchers conducted an environmental scan. This research method uses a systematic approach to gathering information on a specific topic.
What Did the Researchers Do?
Between May to August 2023, the researchers searched for information on all publicly-funded residential treatment programs in Ontario in the ConnexOntario eService portal, a government-funded database. They captured the following information:
- organization name
- location
- program description
- program type (eg, residential addictions treatment or supportive recovery programs)
- eligibility criteria
- intended population
- policies on the use of opioid agonist treatment
- number of available beds
- minimum and maximum length of wait times
- funding source
- fees
They excluded flexible and transitional housing programs, as well as managed alcohol programs, stabilization, or withdrawal management programs. While they excluded privately funded programs, they did include private programs that offered publicly funded components.
What Did the Researchers Find?
There are two types of residential treatment programs in Ontario:
- Addiction treatment programs typically provide more structured, intensive, and time-limited treatment.
- Supportive recovery programs are considered a step down in program intensity and offer a lower to moderate intensity of services and support with generally longer program lengths compared to addiction treatment programs.
Ontario had 102 residential addiction treatment programs and 36 residential supportive recovery programs at the time of the scan. This is three times as many addiction treatment programs compared to supportive recovery programs.
There were large regional differences in terms of the availability of residential treatment programs.
The researchers also found that the information in the ConnexOntario eService portal had limited details about services offered, such as whether the program offered opioid agonist treatment initiation or maintenance.
Regional Differences
The West and North regions had the highest concentrations of residential addiction treatment programs. These regions also had higher rates of beds per capita than other regions for both residential addiction treatment programs and residential supportive recovery programs.
Interestingly, while the North region had among the lowest total wait times for supportive recovery programs in the province, it had the highest wait times for residential addiction treatment programs, by far.
Also, while the North region covers nearly 90 per cent of Ontario’s landmass, the majority of residential treatment programs in this area were found within the four largest urban communities, Kenora, Thunder Bay, Timmins, and Sudbury.
Average wait times were relatively long in the East, Central, and Toronto regions. The East had higher wait times for both types of programs than provincial averages. This region also had one of the lowest rates of beds compared to other regions.
Sex-Specific Programs
There were important sex differences. For example, substantially more residential addiction treatment programs offered services for males only. Nearly half of the available 1,423 residential treatment beds in Ontario were allocated for males, and over half of the remaining beds were available for either males or females. Nearly two-thirds of available residential supportive recovery services in the province were for males, and there were over five times as many beds for males compared to females.
Average admission wait times for residential supportive recovery programs were nearly double for female compared to male programs. One finding of note is that there were no residential supportive recovery services in the Toronto region that accepted females.
Youth-Specific Programs
Only 11 per cent of residential addiction treatment programs were specifically for youth. Half of these were in the West region and a quarter were in the East region. There were no youth-only residential addiction treatment programs in the Toronto region.
Indigenous-Specific Programs
In the North, only one residential supportive recovery program was specifically designed for Indigenous peoples. Another four offered components that are intended for Indigenous peoples, such as holistic treatment that combines traditional and cultural activities with Western-oriented treatment approaches. In the Toronto region, no residential treatment programs offered any Indigenous-focused services or approaches.
Evidence-Based Services
Most residential addiction treatment programs and supportive recovery programs accept clients who are on opioid agonist treatment (OAT) for the management of opioid use disorder. However, many residential treatment programs did not specify whether they offered support for these clients, such as onsite physicians to prescribe or dispense OAT. They also did not specify whether clients were allowed to store their OAT on-site or whether they offered OAT initiation for new clients.
Limitations of the Research
The researchers outlined several study limitations:
- The scan may not have accurately captured all publicly-funded residential treatment programs because different definitions and categories of services were used.
- The broad range of residential service categories included in the scan may have affected the regional variations in wait times and program lengths that were found.
- The data may not have been completely up to date at the time of the analysis.
- There was a lack of clarity around opioid agonist treatment policies, including the definition of taper and detox.
- ConnexOntario categorizes programs by sex but not gender, which may not reflect each program’s practices in terms of accepting and accommodating gender-diverse populations.
How Can You Use This Research?
This study provides a comprehensive overview of current residential treatment options in Ontario, including key details on program provision and characteristics, which are not publicly available. The findings can help inform policy regarding substance use disorder treatment needs and planning. The researchers concluded that their findings point to the need for a comprehensive, centralized, coordinated access database of all essential information to minimize the barriers that service users face to finding, selecting, and accessing needed treatments.
About the Researchers
Farihah Ali,1,2 Justine Law,1,2 Cayley Russell,1,2 Nikki Bozinoff,3,4,5 and Brian Rush1
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
- Ontario Node, Canadian Research Initiative in Substance Misuse, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
- Addictions Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.