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"When we see preventable threats, like substance use, that harm too many people too young, devastate families, destroy communities, and reduce life expectancy, we must act," the medical officer wrote in an annual report released this week.

"In recent years, some of the biggest threats to what had been a steady increase in life expectancy in Ontario have been the COVID-19 pandemic and preventable deaths related to substance use."

Moore's research suggests his "multi-pronged" recommendations can help officials prevent fatal overdoses and stop people, especially youth, from dangerously and increasingly using multiple legal substances.

Hannah Jensen, a spokeswoman for Ontario's minister of health, said in an email on Thursday the government appreciates Moore's "specific viewpoint" outlined in the report, but said recommendations to restrict legal substances while decriminalizing hard drugs are inconsistent.

Jensen said they "ignore the unintended consequences and significant public safety concerns experienced by other jurisdictions that have implemented similar proposals."

She said Oregon, for instance, is considering repealing decriminalization measures passed in 2021 after experiencing "failing audits and increased public safety issues." Legislators in that state tabled a bill earlier this year that would effectively repeal decriminalization measures when passed.

Moore said more than 2,500 people have died in Ontario each year in the past few years due to a toxic drug supply. And the number of opioid-related deaths among teens and young adults in Ontario tripled between 2014 and 2021.

He said research has found a safer drug supply is the solution to immediately prevent thousands more from dying in the coming years.

"The system must first take urgent steps to keep people alive, such as creating safe spaces where people can use unregulated drugs and providing regulated pharmaceutical alternatives," he wrote in the report.

"With these harm reduction responses in place, people who are using opioids may be in a position to benefit from offers of education and treatment, and to make choices that enable them to reduce or even stop their opioid use."

He also recommended Ontario decriminalize simple possession of hard drugs for personal use.

"Decriminalization ... allows the justice and enforcement systems to focus their resources on stopping the organizations and individuals profiting from unregulated drug sales rather than on people who use substances whose needs would be better met in the health system," he wrote in the report.

He noted Ontarians, especially youth, have also been a part of a "disturbing trend" in recent years of binge drinking and vaping.

The report, citing recently released data from the Canadian Institute for Health Information, found 33 per cent of adults said they used cannabis in 2020, an eight per cent increase from 2019. And when it released its cannabis survey in 2022, Health Canada reported the number of Ontarians who died of alcohol toxicity rose 16 per cent between 2018 and 2021.

"We have also seen concerning changes in substance use patterns and harms more broadly, including higher rates of vaping among non-smokers, increased unintentional poisonings in children from cannabis ingestion, and an ongoing high burden of hospitalizations and cancers caused by alcohol," Moore said in the report.

He said that's why efforts need to be made to "shift social norms by making Ontarians more aware of new evidence on alcohol-related harms."

He suggested in the report, for example, that more restrictions on how legal substances are marketed can be implemented to educate people on the harms of substance use.

"The province does prohibit advertising of alcohol to minors on traditional media outlets like television, radio or print, but neither the federal nor the provincial government limits advertising on social media platforms, which is where youth get most of their information," Moore said.

He also recommended Ontario "explore the value of increasing the legal minimum drinking age from 19 to 21" and "work with the federal government to require that all alcohol products have warning labels and signage that describe the risks and harms of drinking booze.

He said it's common knowledge that Ontarians will continue to use the legal substances.

"The challenge is to help people understand the risks, and moderate or stop their use," he said.

He said limiting the number of deaths and hospital visits due to the legal substances can save the province billions of dollars.

"In 2020, the harms associated with substance use cost Ontario about $18 billion – or $1,234 per person – in health care, social and legal/policing costs," the report reads.

Moore argued his recommendations need to be implemented with the understanding that societal burdens, such as the affordability crisis, are driving more Canadians to use substances.

That's why he said Ontario needs to implement his recommendations while working with all levels of government in developing affordable housing policies, programs for families that reduce the risk of adverse childhood experiences and domestic violence, and initiatives to improve social circumstances.

"This report calls for an all-of-society approach to improve health and reduce substance use harms: one that recognizes the complexity of human experience with substances, the factors that drive substance use, and the policy environment where public health policies may conflict with economic policies, and with public attitudes and perspectives," he wrote.

This report by ¹ú²úÓÕ»ó¸£Àû was first published March 29, 2024.

Note to readers: This is a corrected story. A previous version quoted a Ministry of Health spokesperson saying the government appreciated Moore's recommendations. In fact, the province's position is that it appreciates Moore's specific viewpoint.