Tier the Detoxes: How Do We Get In Front of the Toxic Drug Supply?

In my last article I wrote about my experience with the multiple systems addicts usually go through. I was critical of the constantly changing frameworks and the therapese-like language. I find there's no accountability, and I don't think there's a one-size-fits-all solution — everyone is drastically different.

I'll preface this with a few things about myself. I went to school. I had food in my childhood home. Both my parents are alive.

I'd also note that even though those privileges existed at one point, when you're struggling that privilege expires, or gets revoked. When you have nothing and you're very sick, you don't care who's who or who's helping you. That same privilege actually makes you more of a target after the fact — you're more ignorant to struggle. If you're in jail and people think you have access to money, you're an easier target to be extorted.

The core problem, as I see it, isn't that the system doesn't care. It's that we treat clinically different withdrawal cases like they're the same — and the drug supply has changed enough that we can't afford to anymore.

What do the facts tell us?

We have the luxury of looking back in retrospect now. We can see quantified results — when we did x, y happened.

I wanted to look up how many detox beds have been added since I first went through the system, and honestly, I couldn't find much. The 2019 snapshot was about 1,394 residential treatment beds across all of Ontario, and capacity varied wildly — some regions had zero detox beds per 100,000 people. The 2020s brought some expansion through the opioid crisis response, including a new 36-bed detox in downtown Toronto in 2024. But very few brand-new public detox buildings since 2011. Demand has grown faster than supply because of fentanyl, which is why it feels like nothing new exists from a user's perspective.

My proposal: tier the detoxes

I believe we could still use these programs, but we could treat detox more specifically. I'd propose having a dedicated medical detox for poly-substance cases that are more complicated and require more support and intervention. Meanwhile, the traditional existing detoxes could offer faster entry points to treatment and partner with HART Hubs in some kind of collaborative approach.

Here's what tiering could actually look like:

Tier 1 — Non-medical residential detox. For stable withdrawal — meth, cocaine, lighter alcohol cases. Rapid entry, short stay, supportive care. This is what OWMC and similar programs were built for and still do well.

Tier 2 — Supervised medical detox. For moderate-risk cases — opioid dependence, alcohol with a serious history, poly-substance use where vitals are stable. Nurse and physician oversight, medication-assisted withdrawal. This is the tier that barely exists right now and needs to be built out.

Tier 3 — Acute medical stabilization. For high-risk poly-substance cases — fentanyl plus benzos plus alcohol, complex withdrawals that can kill you. Hospital-based monitoring. The Royal's ASU is already doing this; we need more capacity like it.

Right now Ontario has Tier 1 and a tiny bit of Tier 3, with almost nothing in between. Tier 2 is the missing middle, and it's where most modern poly-substance cases would actually fit.

Here's why this matters. In Ottawa, true hospital-based medical detox barely exists. The only dedicated option is The Royal Ottawa, and even that isn't a traditional standalone medical detox — it's a 12-bed Assessment and Stabilization Unit inside the psychiatric hospital. They handle the complex cases — alcohol, fentanyl, polysubstance withdrawal — with medical staff who can use medications and monitor closely.

Before I go further, I want to say something about the people who work at places like The Royal and OWMC. The work that gets done in these buildings happens because of everyone in them — not just the doctors and program directors, but the nurses, the social workers, the counsellors, the cooks who feed you when you can't keep anything down, the cleaners who keep the place livable, the security staff, the front desk people who sign you in when you finally show up. When you're sick and scared and trying to come off something, the person who hands you a coffee or asks if you slept okay matters just as much as anyone with letters after their name. I've been on the receiving end of that and I won't pretend otherwise. Anything I say about the system isn't about the people doing the work — it's about whether we're giving them enough to work with.

The Royal also launched a Day Detox program in late 2025 — a day clinic where people with milder alcohol or opioid withdrawal can get medication and monitoring and go home at night. It's a smart use of limited resources, and the team built something useful with what they have. But it also tells you where we're at: when inpatient beds are this scarce, programs like this end up filling a gap a fuller system probably wouldn't have.

That's it for Ottawa. Twelve inpatient beds plus a daytime program for an entire city. Everything else, including OWMC on Montreal Road where I went, is non-medical — supportive care, counselling, monitoring, but no doctors or nurses providing medications.

Why non-medical detox can't keep up anymore

The toxic illicit supply has changed everything. Fentanyl is mixed with meth, crack, xylazine, benzos. Fentanyl withdrawal is more severe than heroin, faster onset, higher risk of complications — especially when poly-substance use is involved. Non-medical residential programs were designed for lighter or single-substance cases. They still work for those. But poly-substance and heavy fentanyl cases often need medical oversight to avoid medical emergencies and early drop-outs.

The federal piece

Federally there's a program called Reaching Home — the main pot of money for homelessness in Canada. About half a billion a year since 2018. In that same window, homelessness went up 20% and people sleeping outside nearly doubled. The government's own watchdog said cutting chronic homelessness in half would take about seven times what we're spending now. And none of that money goes to detox or treatment anyway — that's a provincial job. So the housing money and the treatment money come from two different governments, and the person trying to get clean is stuck in the middle.

Where this leaves us

Tier the system. Use residential and non-medical detox for the cases it was built for — meth, crack, lighter alcohol, lighter opioid withdrawal. Build out dedicated medical and poly-specific beds for the complex cases that the current model isn't equipped to handle. Partner with HART Hubs and RAAM clinics so people can move between levels of care without falling through the cracks. This isn't radical. The problem is that the build-out hasn't happened, and people are dying while we wait.

What worked for me

I had failed so many times. Each time though, you bring some of what you learned with you. Usually.

I'm a believer in detox. Getting essential ID fast. Staying busy — hygiene, life skills. And honestly, not even so much work right away. I think there's a big rush to get people working when we should be encouraging men and women to build their body, mind and spirit first.

I found trying to do it all at once was very unsuccessful. I focused on the gym and diet first. After a few months I started roofing again.

I started walking. I found myself a cheap pair of headphones and got comfortable walking. I found major success in keeping things simple — wearing the same outfit around the house, having a uniform for home and a uniform for work.

I did a bodybuilder split. I wanted to use more frequent days of the week to get the dopamine and the rush. It made me feel motivated and strong, like I could build off that.

The gym helped me focus on my diet, or at least made me more aware of it, so I started to learn how to cook and meal prep. My first year I ate out every day, roofing.

I didn't drink. I changed the hours I hung out. I learned to hang out with myself and follow my hobbies.

My second year was more credit-related — automating my finances, learning that kind of stuff. I also started trying to question what I want to do, who I was. I researched and asked questions about my self-talk and emotions.

It was not some linear straight-up path. There was just no major self-sabotage, no relapse, no crazy dramatic life situations or stupid angry reactions like I'd had in the past.

That's not a program. That's not a framework. That's just what worked for me. And I think if we built a system that gave people the time and the tools to do those things — instead of rushing them through detox into work into relapse — we'd see different results.

Bringing it together

What I keep coming back to is this: when we get specific, when we put people in the right position for their situation, treatment works better. A poly-substance fentanyl case needs medical detox. A meth or alcohol case can do well in residential. Someone six months out doesn't need the same thing as someone six days out. The current system treats people roughly the same and hopes for the best. Tiering it — matching the level of care to what the person actually needs — would change outcomes.

The other piece is that if we're serious about treating the most vulnerable, the supports have to match the reality. Most people coming out of addiction need access to ODSP, and if they're already on it, they need additional funding for the basics that actually rebuild a person — protein, supplements, dental work, basic health care. You can't ask someone to gain the confidence and trust to participate in society when they don't feel good in their own body. When their teeth hurt. When they can't afford to eat properly. These aren't extras. This is the floor. Without it, you're asking people to climb out of a hole with no rope.

If you or someone you know is trying to navigate this right now, ConnexOntario (1-866-531-2600) is free, confidential, and runs 24/7. They can tell you what's actually available.