More than 47,000 Canadians have died of opioid toxicity since 2016. Some have attributed this crisis to the over-prescription of medical-use opioids and the presence of potent synthetic opioids like fentanyl analogues in the illicit drug market.
As a response, one of the strategies the federal government has adopted is harm reduction — an approach aiming “to reduce the negative health, social, and economic impacts of substance use related harms, without requiring or promoting abstinence.”
Common measures of this model include the provision of free and sterile needles to high-risk users and supervised consumption sites (SCS) where users consume substances under the guidance of medical professionals.
Some politicians and commentators are skeptical of some harm reduction measures, especially SCS. However, scientific evidence shows its effectiveness in reducing overdose deaths and risky behaviours associated with the spread of HIV and viral hepatitis.
Alberta’s priority on recovery and treatment
In 2019, the United Conservative Party (UCP) government released a report on the socio-economic impacts of SCS in Alberta, contending that these sites led to increased needle debris and violent crime, even though studies show that SCS do not cause more drug-related crime.
Two peer-reviewed scientific papers, one published in the Harm Reduction Journal and another in the Canadian Journal of Public Health, have debunked misinformation in the province’s report. For instance, a group of scientists found that the report relied on anecdotes and pseudoscientific statements to argue against SCS, and selectively ignored evidence showing its positive impacts.
Nonetheless, soon after the report came out, the Alberta government shut down two SCS, one in Lethbridge and another in Edmonton.
In 2021, following recommendations from the 2019 Mental Health and Addictions Advisory Council, the government established the Alberta Recovery Council to implement what it called a “recovery-oriented system of care,” which prioritizes treatment of and recovery from substance use over “acute interventions designed to manage the negative health effects” of issues related to addiction and mental health. Alberta’s 2022 provincial budget invested more than $1 billion per year for the subsequent three years to increase access to this type of care, including creating more treatment spaces.
The same year, the UCP government implemented a new licensing requirement for all SCS. Users are now required to show their ID when visiting SCS, and SCS staff are obligated to refer users to addiction treatment. Critics worried that the lack of anonymity could prevent users from supervised consumption and hence lead to more overdose deaths and risky injection behaviours. Earlier this month, the government announced its anticipated closing of Red Deer’s SCS in spring 2025.
Not enough evidence to prove Alberta’s success
The UCP government has recently suggested that its model is a success, but these claims are based on limited data and need closer examination. The Alberta Substance Use Surveillance System indicates that the number of opioid-related deaths in May 2024 was lower than in preceding months and also lower than the previous May. The surveillance data also shows the total deaths from January to May 2024 is lower than the same period last year.
On social media, Premier Danielle Smith characterized the statistics as an indicator of the success of her government’s policy, claiming, “Alberta’s recovery-focused approach is showing real results.” Alberta’s Minister of Mental Health and Addiction, Dan Williams, has been quoted crediting the province’s policy for saving lives.
However, the most recent data are likely not enough to prove the effectiveness of Alberta’s approach to treatment in reducing opioid-related deaths. While the first half of 2024 seems to exhibit a drop in deaths, it is important to note that over 1,800 died in 2023, a record high since 2016.
That record high occurred four years after Jason Kenney’s UCP government committed $140 million to addiction recovery, including opening 4,000 treatment spaces; three years after the shutdown of Lethbridge’s SCS; and two years after the Recovery Council’s formation.
More importantly, the data in the surveillance system is incomplete. It only counts certified deaths due to drug poisoning and “apparent unintentional fentanyl related deaths” that are inferred from initial circumstances but not yet confirmed by a medical examiner. Because it can take six months or longer for a medical examiner to make a final decision on the causes of a death, the numbers in recent months and even years can change.
Deaths don’t tell the whole story
Moreover, the number of deaths by drug poisoning alone is insufficient to show the efficacy of a policy. To understand the full scope of the opioid crisis, we need the total number of opioid-related overdoses, not just the deaths. Survivors of opioid overdose are at greater risk of dying in the year after, but their deaths are often caused by factors other than poisoning, such as hepatitis.
This suggests that treatment of addiction is not enough. Harm reduction is also necessary to curb other negative consequences of substance use, like the spread of infectious diseases.
The United States is reporting a slight decrease in opioid overdose deaths recently. However, one must be careful to attribute this decline to successful public health measures. Other factors, such as the changing landscape of drug supply and the ability of users to better detect contaminants, could be in play. This implies that any future decreases in deaths could be due to reasons other than the UCP’s policies.
We still do not know if Alberta will have fewer opioid toxicity deaths in 2024. Even if there is going to be a decline, whether it is attributable to the province’s recovery-focused approach is questionable. Some have argued that the UCP’s language of recovery and its rejection of harm reduction seems to be based on ideology rather than rigorous scientific evidence.
The impact of the recovery model remains to be seen. More evidence is needed to establish its success.
The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.
This article was originally published on The Conversation. Read the original article.
