Canadian opponents of harm reduction have been pointing to recent data from Alberta as proof the province’s treatment-based approach to drug policy is successful. There are good reasons to believe these conclusions are not only premature, but deeply flawed.
Pierre Poilievre, leader of the Conservative Party of Canada, made a surprise onstage appearance at a Recovery Day street festival in British Columbia on September 7. There, he pointed to a 55-percent decline in opioid-involved overdose deaths in Alberta.
Poilievre claimed the provincial policy of heavily emphasizing recovery and abstinence, while subordinating harm reduction, was the reason for the decrease.
The 55-percent decline figure is obtained by comparing opioid-related deaths in the month of May 2024—which saw 73 reported overdose deaths, of which 72 were opioid-related—to May 2023, when there were 177 overdose deaths, including 161 that were opioid-related.
Poilievre, who has come out hard against harm reduction since he was named party leader, often scapegoating drug users for issues of public disorder, wasn’t the only one pointing to the figures as proving the “Alberta model.”
“It just validates that this recovery-oriented system of care is working,” Earl Thiessen of Oxford House Foundation, a recovery program in Calgary, told CTV News.
Fatal overdose counts by month, via Alberta Health Services
Earlier in the year, the conservative National Post newspaper claimed in a headline that Alberta’s data from April “proves recovery model naysayers wrong.” It pointed to figures for the first four months of the year, which showed a 30-percent decline compared to the first four months of 2023.
“Neighboring British Columbia, by comparison, saw a more modest 13 per cent drop in year-to-year deaths,” columnist Rahim Mohamed wrote.
Monty Ghosh, a professor at the universities of Calgary and Alberta, and an addictions doctor, called the release of May’s data “a benchmark moment.” He told CTV the decline was attributable to changes in the drug supply—including reductions in the role of carfentanil in deaths—but that the biggest reason was treatment getting people off of street drugs. He also noted the role of harm reduction, according to CTV.
“Back in 2022, the Alberta government cooked the books to try and prove that its model was working. We caught them doing that.”
But Euan Thomson, an independent drug policy analyst and author of the Drug Data Decoded newsletter, said it’s too early to take any lessons from the data this year. He noted the Alberta government has relied on early data in the past to paint a rosy picture of the province’s model.
“Back in 2022, the Alberta government cooked the books to try and prove that its model was working. We caught them doing that,” he told Filter. “They were releasing data far before they were complete, and then making policy around that false data.”
While BC uses a coroners service to investigate causes of deaths, Alberta uses a medical examiner model. Thomson said this is a better model, as it means a more in-depth and accurate look at causes of death. But it also means data take longer to finalize.
When any province, but particularly one with a medical examiner model, publishes its monthly data, those numbers are still not complete. They will change in the coming months, and even over the course of years, as more investigations conclude.
In BC, death totals originally announced in 2023 monthly releases have increased by an average of 10.7 percent as of August. The 2022 figures have increased by an average of 11.3 percent from their original announcements.
Equivalent increases in Alberta tend to be higher, according to data provided by Thomson—with an average increase of 12.4 percent over the original numbers released in 2023, and an average of 18.7 percent for the 2022 monthly numbers.
It looks likely a substantial year-on-year decrease will remain. However, that is unlikely to be attributable to much that the province has done, Thomson said.
Alberta’s figure for February was originally 114, but has since increased by more than 13 percent, to a current total of 129. The March figure has jumped by nearly 16 percent, from 127 at original release to 147 in the most recent data.
Still, even adding 15 percent to the May 2024 number would bring that month to 84 deaths—less than half the number of deaths a year prior. It looks likely that a substantial year-on-year decrease will remain.
However, that is unlikely to be attributable to much that the province has done, Thomson said.
He noted that 8 percent of participants at Calgary’s supervised consumption site were overdosing in mid-2023, when deaths were peaking. That’s since dropped to around 3 percent. It’s an indication that the decline is attributable more to how people and drugs interact—whether changes in the supply, or people adapting to the supply.
“Most people have switched over to smoking, for example,” Thomson said. “So this isn’t a static crisis. It’s always changing, and people are changing with it. People are changing their habits in response to how the drug supply presents itself, month over month and year over year.”
“There’s no government in this country that’s rolling out policy at an appropriate scale that is meant to reduce deaths,” he added, but “Alberta is among the worst offenders.”
“The BC model and the Alberta model, despite some differences, also overlap quite a bit as well.”
In past media appearances and in an interview with Filter, Dr. Ghosh said Alberta’s drug policy has been widely mischaracterized, even by the government itself.
BC has ostensibly taken a more pro-harm reduction stance, despite its government repeatedly backsliding in recent months.
“The BC model and the Alberta model, despite some differences, also overlap quite a bit as well,” Ghosh said.
While the Alberta government has outwardly been critical of harm reduction, he noted that the province has largely retained its supervised consumption sites, unlike Ontario, which is planning to close 10 sites.
One thing Alberta has also leaned into, according to Ghosh, is opioid agonist therapy—particularly buprenorphine, but also methadone—making those drugs available through virtual platforms, through phone lines and through police officers and social workers.
Alberta also has some level of injectable OAT programming. However, one of its primary differences with BC is its opposition to safe supply programs that aren’t intrinsically geared towards recovery outcomes.
Harm reduction advocates in BC have also argued that the two provinces’ policies are not so dissimilar—noting that BC’s safe supply program is highly limited, with the number of people accessing it continuing to decline, and that the decriminalization pilot project was nominal and not designed with people who use drugs in mind.
However, while safe consumption and overdose prevention sites are still scarce in BC, they are even less accessible in Alberta, Thomson said.
Though Ghosh noted that a Lethbridge supervised consumption site closed by Alberta in Lethbridge was replaced by a mobile unit, Thomson said it’s not that simple, as drug inhalation services and others were reduced—together with overall access. At its peak, the Lethbridge site saw 66,000 visits per quarter, which dropped to 6,000 after the change, Thomson said.
One study out of Athabasca University found that people who used the mobile unit “reported feeling less safe due to the potential for violence near the motorhome, and less likely to use it overall due to location and lack of support services.”
But Thomson said the lack of inhalation services is a big issue, as the mode of consumption has largely shifted to smoking drugs.
Similarly, the Calgary SCS has seen usage drop from 20,000 per quarter to 10,000, which Thomson said is at least in part due to the site pressuring participants to disclose their personal health numbers and go into treatment.
Total visits (top) and unique visitors by quarter at Alberta supervised consumption services, via Alberta Health Services
Alberta’s reported overdose figures could have been lower still if full access had been maintained. Thomson pointed to one study looking at the opening of nine sites in Toronto, where surrounding neighbourhoods saw a decrease in overdose deaths not reflected in other areas.
Despite this, the BC Conservatives are among those pointing to Alberta as a reason to reduce harm reduction.
Ghosh said this is the wrong conclusion to reach, given Alberta still has supervised consumption sites, and given the many factors that may be impacting overdose rates in the province.
But Thomson said it’s too early to reach any conclusions.
Indeed, in September, when Poilievre touted the reported decline in Alberta deaths, it wasn’t the first time he’d made such a proclamation.
The trouble with Poilievre’s claim in 2022 was that the decline in Alberta deaths was a fleeting reprieve.
Sitting in Vancouver’s CRAB Park in November 2022, using the tent city there as a backdrop, he made a similar claim.
“In that tent city are people hopelessly addicted to drugs,” Poilievre said into a camera.
He painted the then-300 percent increase in BC overdose deaths over six years as the result of permissive drug policies, particularly blaming safe supply—which at the time involved only a few thousand people and had been in place just a couple of years.
Poilievre meanwhile praised Alberta’s policy of treatment over harm reduction as “proven to work.”
“In Alberta, today, they’ve managed to cut overdose deaths by almost half by getting people into recovery,” he said.
The trouble with that claim, however, was that it was a fleeting reprieve.
The “almost half” decrease at that point has since shifted to a roughly 35-percent decrease, as the numbers have been updated over the years.
And while a decrease of over a third is still substantial, it was only temporary. 2023 became the deadliest year in Alberta’s history, with five months seeing higher rates of overdose deaths than BC.
Chart compiled by Dustin Godfrey
That 2023 surge is important context for the recent apparent decline—context conspicuous by its absence from media reporting on the latest figures.
“I will absolutely reaffirm that media has once again played a really harmful role in this,” Thomson said. “Instead of questioning the accuracy of the data, we’re just seeing default acceptance.”
Photograph (cropped) of Pierre Poilievre in 2022 by Taymaz Valley via Flickr/Creative Commons 2.0