Since 2016, more Albertans have died of opioid poisoning than COVID-19 in the province. While the provincial government, albeit reluctantly, followed public health advice to keep Albertans safe from COVID-19 deaths and hospitalization, their approach to the concurrent pandemic of opioid deaths completely misses the mark.
The opioid crisis is a poisoning crisis rather than an overdose crisis. Those who die of opioid poisoning do not intentionally take too much of their drug of choice. Rather, they take a usual amount of a toxic supply. Street drugs in distribution since 2016 contain potent, lethal and unpredictable doses of narcotics.
The UCP government recently announced an increase of 8,000 treatment beds for Albertans suffering from substance use disorders and five long-term treatment facilities to help people make lifestyle changes and build life skills. While these changes will increase access to Albertans seeking rehabilitation and treatment, they have limited value in reducing deaths from opioid poisoning.
Data from the United States shows only 10 per cent of people with active substance use disorders enter treatment, and less than half complete it. Harm reduction services are needed for the 90 per cent or more people who cannot or will not enter treatment. A recovery-focused approach implies that if you cannot stop using, your life is not worth saving.
The UCP government is not preventing Albertans from dying due to the toxic street drug supply. They closed safe consumption sites in Lethbridge, Edmonton and Calgary precisely when more needed to be opened to keep Albertans safe. They limited access to a safe supply of pharmaceutical grade narcotics to specialized clinics in four cities. This effectively cut off access to rural Albertans and forced those with previous access from clinics and pharmacies, closer to home and across the province, to travel daily or go without this life-saving treatment.
A more comprehensive public health approach is needed for keeping people and communities safe and healthy. In July 2020, the Canadian Association of Chiefs of Police (CACP) endorsed a framework addressing the opioid crisis that consisted of supervised consumption sites, safe supply, diversion programs and decriminalization of simple possession of illicit drugs.
They recognized decriminalization cannot be an isolated strategy, but one embedded in a framework of treatment, harm reduction, enforcement and prevention. With decriminalization, possession of small quantities of illicit drugs remains illegal, but fines and warnings rather than criminal conviction are the punishment. Production and trafficking of illicit substances will continue to be criminal offences that are actively enforced and prosecuted.
Decriminalization allows people who use drugs to access services and supports without fear of being arrested. It also provides police the opportunity to connect them with life-saving resources instead of charging or imprisoning them. Diversion from criminal consequences to important community resources such as treatment facilities, and housing and employment supports, will have a positive impact on the individual’s life. When people who use drugs get their health and social needs addressed, they are not forced into theft, trafficking or sex work to maintain their substance use. Diversion enhances community safety by reducing crime.
Most fatal opioid poisonings occur when people use drugs alone. CACP and public health officials advocate for the establishment and continuation of supervised consumption sites. These provide a clean and safe environment for people to use drugs knowing that they have access to emergency services and trained personnel. Supervised consumption sites reduce the risk of overdose, decrease the spread of infectious diseases such as HIV, and connect people with services like health care, housing and employment. They also have benefits for the community by reducing public drug use, fewer discarded drug use equipment littering streets and decreased strain on emergency medical services.
Ensuring a safe supply of opioids is also a crucial strategy in ending the overdose crisis. Being unregulated, street drugs were always at risk of being contaminated but the emergence of fentanyl in the illicit market has made the supply unpredictable and lethal. In 2018, the federal government committed to providing safer alternatives to the contaminated drug supply on the street, yet Canadians continue to die from opioid poisonings because access to these therapies is severely limited to a few isolated clinics across the country.
When people who use drugs have a secure and predictable supply of pharmaceutical-grade opioids they are much less like to die of opioid poisoning. They are also less likely to be forced into criminal activity to support their drug use, improving public safety for all in the community.
Alberta has the second highest per capita opioid deaths in Canada – after British Columbia – where simple possession of illicit drugs has been decriminalized following endorsements by the British Columbia Chiefs of Police and the CACP. It is perplexing then that the Alberta Chiefs of Police went on record a few weeks ago opposing decriminalization in Alberta.
We need to demand the same level of protection and public safety given to other Canadians. Albertans who use drugs deserve the chance first, to be alive and healthy and then, if they are ready, chose the path to recovery.
Vamini Selvanandan is a rural family physician and public health practitioner in the Bow Valley. Her commentaries appear in the Rocky Mountain Outlook on the third Thursday of each month. For more articles like this, visit www.engagedcitizen.ca.