Expanding the Scope of Social Work Practice to Confront the Drug Toxicity Crisis: Policy Barriers and Opportunities for Legislative Reform In Canada

Background and Purpose

Over the past decade, Canada has witnessed a total of 53,308 accidental deaths, 50,558 hospitalizations, and 208,615 emergency department visits related to drug toxicity. Accidental drug overdoses are now the leading cause of death among people 20–44 years of age in Toronto, the largest city by population in Canada and the fourth largest in North America. These deaths are preventable. Yet, despite more than three decades of evidence supporting the effectiveness of harm reduction approaches for substance use disorders, new laws and policy directions are seeking to end needle exchange programs, safer opioid supply initiatives, and supervised consumption sites (SCS). The loss of such life-saving supports is expected to generate ripple effects across the health system and may increase preventable harms, including delayed treatment initiation, avoidable hospital utilization, and escalating system costs. In this context, expanding health workforce capacity is no longer optional, it is an urgent system response. This presentation examines the legislative and policy frameworks that limit social workers’ participation in key domains of clinical practice and provides recommendations to expand the scope of social work practice to enhance supports for people who use substances and increase health system capacity in response to the drug toxicity epidemic.

Methods

Using a socio-legal approach, and the frameworks of historical institutionalism and path dependence, this presentation offers a critical analysis of the legislation and policies that limit the scope of social work practice in Ontario, Canada. Expanding the scope of social work practice is a timely and evidence-informed strategy to meet this growing service demand. Social workers remain underutilized in addressing substance-related harms despite competencies in clinical assessment, diagnosis, care planning and coordination, psychotherapy, harm reduction, and systems navigation.

Results

Findings from this policy analysis focus on several recommendations. To optimize the services and supports for people who use substances, the social work profession must be integrated across primary health care, the main entry point into the broader health care system. Amending legislation to grant social workers the ability to assess, diagnose and communicate the diagnosis directly to clients would help to enhance the capacity of the health care system to support those living with substance use disorders.

Conclusions and Implications

This presentation will provide a critical analysis of the legislative and policy frameworks that limit social workers’ optimal participation in key domains of clinical practice and provide recommendations to expand the scope of social work practice to enhance health system capacity in response to the drug toxicity epidemic. This presentation closely aligns with the Society for Social Work and Research (SSWR) Conference 2027 Substance Misue and Addictive Behaviours cluster, covering the following topic areas: Substances: Alcohol, Tobacco, Prescription and Other Drugs, Intervetion: Prevention, Treatment, Services, and Recovery, and Substance Misuse and Addictive Behaviors Policy. At a time when health systems are under growing strain and specialist capacity remains limited, expanding the role of social workers offers a practical and scalable strategy to strengthen timely assessment, improve access to care, and enhance support for people who use substances.