By mid November, the COVID-19 pandemic is linked to nearly 450 deaths in Alberta and 10,000 deaths nationwide. Meanwhile just out of sight of most Albertans, the opioid epidemic continues to take its toll. Since 2016, in Canada, opioid accidental deaths are approaching 20,000. The Alberta death toll to date is 3,550. Fentanyl is the main culprit, linked to 2,500 deaths. Carfentanyl a more potent derivative caused over 400, and non-fentanyl (mostly amphetamines) another 600.
While fentanyl is very dangerous, some people use harder drugs such as cocaine, methamphetamine and MDMA (ecstasy).
Governments basically arrange their responses along a continuum with five elements:
- Education and prevention
- Harm reduction
The first four elements are standard responses to addictions, but harm reduction is more controversial.
The policy question is: should public support be provided to addicts in the interests of keeping them from further harm and perhaps death? The opioid epidemic has added new urgency to harm reduction efforts. Fentanyl is so dangerous that accidental death is an all-too-common outcome.
Harm reduction does work at reducing deaths and salvaging lives. A two-year study of 1,000 people across several centres in Switzerland found “substantial improvements for illicit heroin use, health status and crime among highly addicted patients.”
Addicts often take many tries and years to get to sobriety. And some are so deeply addicted that they cannot escape.
Harm reduction options are:
- Naloxone kits – These kits have a needle and a dose of Naloxone which can reverse the effects of a fentanyl overdose. In Alberta there are 2,000 pharmacies and community agencies that offer these kits free of charge. 271,681 naloxone kits were dispensed, and 18,374 overdose reversals have been reported.
- Supervised Consumption Sites (SCS) There are seven sites in Alberta – four in Edmonton, and one each in Calgary, Lethbridge and Grande Prairie. Drug users can take their illegal drugs to the SCS. The goal is to provide clients with a safe location to reduce harm from tainted or fentanyl laced drugs. The Alberta government conducted a review of the supervised sites and discovered a number of community-related issues such as increased crime and needle debris near some of these sites. They also found financial issues with the Lethbridge site and closed it down.
- Oral Opioid Agonist Therapy – (OAT) Addicts are referred by doctors and proscribed methadone, or an opioid called buprenorphine. The drugs are covered by medication funding plans e.g., Blue Cross.
- Injectable Opioid Agonist Therapy. – (iOAT) This is a last resort for clients who have been unsuccessful at OAT. Clients in this program can inject hydromorphone under supervision. The Alberta government has announced that the OAT and iOAT pilot projects in Alberta will not be funded next year; although the federal Health Minister has urged the province to reconsider.
The Premier is not a fan of some harm reduction options. He says: ‘Handing somebody who’s deep in addiction a needle is not a continuum of care.” “Handing out free narcotics to addicts is not compassion”. “If you think the harm reduction obsession is really successful when it comes to preserving human lives, then I invite you to take a stroll down East Hastings on the downtown east side of Vancouver.”
His point man on addictions, Jason Luan, Associate Minister of Mental Health and Addictions added a fiscal consideration to the debate: “the government is not entertaining any proposals using taxpayer money to buy drugs to sustain any form of addiction”. Instead, he is focused on increasing treatment capacity.
The main treatment options for addictions for adults includes short term outpatient counselling, education, support group programs and residential treatment. There are 73 treatment facilities in Alberta with 566 publicly funded beds for residential addiction treatment.
The Alberta government plans to spend $140 million over four years to improve access to a treatment services. $40 million is earmarked for opioid related services. To date, the province has announced about $80 million in funding. The province has also eliminated the $40 per day cost of treatment at its facilities.
Severely Normal Albertans might take a more balanced view than the Premier. The reality of addictions is more complex than his soundbites. Associate Minister Luan is leading the charge to improve and expand residential treatment services. The battle with the epidemic of addictions and fentanyl deaths deserves to be attacked with the same rigour we apply to the pandemic.