As an experienced harm reduction nurse in Alberta, Corey Ranger has been on the front lines of the overdose crisis. He’s worked in a few safe consumption sites (SCS) in the Canadian province, and has seen how they, and related measures, can curb overdose deaths.
But now the province’s ruling United Conservative Party (UCP)—which defeated the center-left New Democratic Party (NDP) in the provincial election in 2019—is moving quickly to remove a slew of harm reduction programs. These include the June axing of planned phone-in consumption sites and the August closure of North America’s busiest SCS, ARCHES, in the city of Lethbridge.
Last spring, Ranger moved out west to British Columbia to continue his work.
While other Canadian provinces are developing or considering harm reduction programs, the Government of Alberta is, instead, opting for a wholly treatment-based approach. The move drew praise in the form of an op-ed in the Edmonton Journal—the paper of record in Alberta’s capital—from Alberta Addiction Service Providers, which did not respond to Filter’s request for comment.
But it has also earned criticism from numerous public health researchers and harm reduction advocates. Ranger himself penned an article calling the approach a kind of “social murder,” as a set of policies that could result in the deaths of vulnerable people.
“It’s a harsh term, but it’s appropriate. If the shoe fits… and it does right now,” he told Filter.
Premier Jason Kenney of the UCP announced that Alberta would not be offering a safe supply of drugs.
In early October came a fresh rejection of harm reduction. Premier Jason Kenney of the UCP announced that Alberta would not be offering a safe supply of drugs—a strategy backed not only by harm reductionists, but by Canadian Prime Minister Justin Trudeau.
Other provinces, such as British Columbia and Ontario, are either looking into or already offering safe supply programs, where people who use street drugs receive regulated substances through the healthcare system as an alternative.
Gillian Kolla, a postdoctoral research fellow with the Canadian Institute for Substance Use Research at the University of Victoria, BC, called the Alberta government’s moves “very puzzling.”
Dr. Kolla told Filter that drugs offered through safe supply programs are less risky than street drugs because their dosage is known and because they don’t contain other, potentially dangerous compounds. While safe supply programs are relatively new, there is evidence that they can be an effective tool in stemming overdose deaths.
Between April and June, or Q2 of 2020, 301 people in Alberta died of apparent opioid-involved overdoses, the Edmonton Journal reported. This is a marked increase, and higher than Q4 of 2017 and Q3 of 2018, in each of which 211 people died—the province’s previous highest death rates.
The UCP government’s response was to announce $140 million in funding for mental health and addictions programs—with $40 million dedicated specifically for opioid addiction—and $53 million to enhance addiction recovery supports, including online and phone-in efforts. In a press release, it also announced $25 million to create five recovery communities around the province, as a part of the province’s recovery plan.
Filter reached out to the province about the decision, and was directed to reporting in Canadian newspaper the National Post containing comments from Jason Luan, Alberta’s associate minister of addictions and mental health.
“When people suffer from addiction, everybody knows the reason they’re addicted is it’s beyond their personal control, we must help them, support them in a way to get out of this, rather than just let that addiction rampage,” Luan said in the article.
The UCP’s tactics are largely based on their notion of morality, rather than practicality, Ranger said.
According to Ranger, abstinence-only treatment models often do not meet the needs of people who use drugs, and can generate other harms as well. A person who enters a program where abstinence is required will lose their tolerance to the drug they were using. So, if they return to use and take a similar dose to what they were taking pre-sobriety, it is more likely to cause an overdose.
The UCP’s tactics are largely based on their notion of morality, rather than practicality, Ranger said. For example, rather than closing ARCHES outright after its alleged mismanagement of government funds, the province could have installed a public trustee or another group to manage it.
Earlier, the province announced plans to cut funding for the Injectable Opioid Agonist Treatment program (iOAT), a two-year hydromorphone pilot started by the NDP. According to an email from Kassandra Kitz, press secretary for Associate Minister Luan, iOAT was slated to end on March 31 of this year, but the UCP extended it an additional year to “allow for the safe transition of the pilot participants into existing clinics where similar services are available.”
The email also notes that iOAT clients can still access similar programs—offering medications like methadone and Suboxone—through 10 opioid dependency clinics around Alberta. Additionally, 40 percent of iOAT clients have already moved to these alternatives, Kitz wrote.
But, according to Elaine Hyshka, assistant professor at the University of Alberta’s School of Public Health, iOAT was largely used for people who have previously tried traditional opioid agonist treatments, like methadone, without the ability to inject. Most iOAT clients are people with severe opioid use disorder (OUD), for whom traditional options have not worked.
“By getting rid of [iOAT], they are getting rid of an option, the only option for a subset of people with opioid use disorder,” she said.
The elimination of iOAT may not be a certainty, however. On October 21, it was reported that the Alberta government faces a lawsuit alleging that suspending the program would violate patients’ constitutional rights. Associate Minister Luan then hinted that the option could remain available in the province beyond its revised end-date of March 2021.
Dr. Hyshka noted that there are three primary, evidence-based interventions to prevent overdose deaths and treat people with OUD: naloxone kits, SCS and agonist treatments. Naloxone is still offered in the province, and the availability of agonist treatment, at least in traditional form, will continue. But there has recently been a marked move away from SCS (as of January, before the closure of ARCHES, Alberta had seven sites remaining).
Beyond this, she told Filter, it’s important for governments to consider new ideas instead of only relying on old stand-bys. “When you look at the overdose numbers in Alberta and across the country, they have never been worse. We’re in uncharted territory when it comes to so many people dying.”
Alberta, like other places with rising opioid-involved deaths, also needs to investigate and deal with the root causes behind addictions, Hyshka added. Factors like trauma and poverty increase the number of people who develop problematic relationships with drugs. “As part of a bigger picture, we need to be talking about that and addressing it as a society.”
“Putting all our eggs in that particular basket doesn’t help us.”
According to Scott Bernstein, director of policy with the Canadian Drug Policy Coalition, harm reduction strategies and treatment methods should go hand-in-hand, rather than being seen as mutually exclusive. Simply focusing on getting people off drugs without worrying about overdoses or supporting people to the point where they may feel ready to take on treatment isn’t likely to be that effective on its own.
“Putting all our eggs in that particular basket doesn’t help us,” Bernstein told Filter.
Many referrals to treatment centers also come from harm reduction operations, which, he said, offer settings that are more accepting of people who use drugs. But decriminalization—an idea that Prime Minister Trudeau said was not a “silver bullet” to stop overdose deaths—is an important factor in (among other things) reducing the stigma that prevents people who use drugs from accessing services. Numerous organizations around Canada have recently called for the decriminalization of drugs, including even the Canadian Association of Chiefs of Police.
The stigma that surrounds drug use is also found in the healthcare system, said Kolla. If a person overdoses and ends up in the emergency room, for example, they may encounter negative reactions that make them wary of interacting with the system another time. Decriminalization, which is the subject of national debate but not currently being explored in Alberta, could reduce such risks. But even without decriminalization, harm reduction programs “meet people where they are at, and [offer] them an open door,” Kolla said.
Alberta is one of the most politically right-leaning Canadian provinces. In the past, Albertan voters re-elected the center-right Progressive Conservative Party—which merged with the right-wing Wild Rose Party to create the UCP—for more than 40 years in a row. And in many cases, harm reduction is viewed as something of a four-letter word in conservative circles.
According to Ranger, there is a good deal of money in the treatment model, which is also a factor. And, while both harm reduction and treatment organizations tend to be nonprofits which receive government funds, there is a disproportionate amount of oversight placed on the former, compared to the latter.
This worrying period in Alberta could have broader implications.
But Bernstein noted that not everyone on the political right has the same view on drugs and the people who use them. Libertarians, for example, may see drug laws as an encroachment on fundamental rights. That said, he added, speaking out against harm reduction programs can generate political clout for right-wing politicians.
“There’s this ‘get tough on crime’ mentality that wins votes in a certain segment of the population that doesn’t want to look at the situation from a place of compassion,” Bernstein said.
All the same, tackling overdose deaths needs multiple approaches, Hyshka said. And using harm reduction to save lives shouldn’t be a partisan issue: “Wherever you stand on the political spectrum shouldn’t matter.”
This worrying period in Alberta could have broader implications. Back in March, the government released the findings of the Supervised Consumption Services Review Committee, which was meant to gauge the impacts, both social and economic, of SCS. The negative findings have since been called into question, but have still become a data point that governments and organizations looking to axe harm reduction programs could leverage.
“It has the potential to create harms for harm reduction services both in the country and abroad,” Ranger said.
Photograph by WR2012 via Wikimedia Commons/Creative Commons 2.0