Delay in fentanyl treatment plan ‘garbage,’ expert says
The Alberta government’s threeyear plan to open new treatment spaces for fentanyl users is already facing a stinging rebuke before it has even been released.
Six months after Alberta’s health authority revealed it had a draft treatment plan to cope with a spiralling addictions crisis, the province is expected to announce the multi-year strategy in the “near future.”
The plan will expand access to methadone and suboxone, widely considered ideal treatments for users addicted to fentanyl and other opioids, as health officials grapple with a crisis that has left almost 500 Albertans dead from fentanyl overdoses since 2012.
Delays to release the plan come as users in Calgary — the epicentre of the province’s crisis — are waiting about 35 days for treatment at the city’s only publicly run methadone clinic.
An addictions specialist questioned why the Alberta government has taken so long to develop its treatment strategy as the province’s fentanyl crisis rages.
“On one hand you have the minister saying we’re treating it as a life-or-death situation,” said Dr. Hakique Virani, who treats patients at an Edmonton methadone clinic and teaches at the University of Alberta. “On the other hand, you’ve got a plan that’s been there since October; that’s a multi-year plan.
“It’s sort of like saying if somebody presents to emergency with a heart attack, let’s have a multidisciplinary conference and think how we’re going to address this heart attack over the coming three years. It’s garbage.”
Fentanyl, a highly addictive drug that can be lethal in small doses, has become a mainstay in Alberta’s drug trade in part because it’s easily accessible on the Internet, yields big profit margins for dealers and is incredibly addictive. Once they’re hooked, users say withdrawal is excruciating, which compels them to find their next fix.
An Alberta Health spokesperson defended the department’s response to the crisis, noting more than 600 sites across the province now dispense life-saving medicine called naloxone, an injection that stops fentanyl overdoses. The official noted the NDP government will spend $3 million running methadone clinics this year, an increase from nearly $2 million budgeted in 2015-16.
Kathryn Todd, a senior executive at Alberta’s health authority, said delays in releasing the methadone and suboxone strategy are due in part to lining up partners, such as social agencies, pharmacies and police.
In October, Alberta Health Services revealed that senior decision-makers had been considering a draft treatment model to cope with spiralling opioid addictions. At the time, another executive at the health authority said delays were caused by a “big bureaucracy” that needed time to weigh various considerations and ensure the work is done according to “standards and best practice.”
Todd, the vice-president responsible for addictions and mentalhealth programs, said in a recent interview the strategy will seek to identify the root causes of addiction faced by patients and link them with other services they may need to stay clean, such as housing and help finding work.
“It’s more than just beds, because this involves a broad range of folks that are using opiates, and we want to make sure we’re targeting a broad range and providing the appropriate services,” Todd said. “That’s why, I think, it’s taken as long as it has, but my understanding is that Alberta Health will be making an announcement in the near future.”
The strategy will provide methadone and suboxone treatments in at least three Alberta communities “that are lacking in this area,” including the southern Alberta town of Cardston, where a clinic will begin offering these services in May.
Doctors at Virani’s Metro City clinic in Edmonton will provide care for patients in Cardston via video conferencing and personal visits. Virani said there is considerable demand for methadone and suboxone in the surrounding area, especially in the nearby Blood reserve, which has seen a surge of fentanyl abuse and more than 20 overdose deaths since the summer of 2014.
“We’re using docs that could be run off their feet in Edmonton just meeting the demand here, to try and help temper a problem in Cardston,” he said. “It’s not perfect.”
There are seven methadone clinics in Alberta, including two run by Alberta Health Services, which treats a minority of the estimated 4,000 to 5,000 patients receiving the therapy. A new clinic opened in Medicine Hat in recent months, though it’s run by a private practice.
Two doctors on the Blood reserve have also been offering suboxone at their clinics, though they’re struggling to keep up with demand.
Methadone and suboxone are opioid replacement drugs that satisfy cravings but do not produce euphoria, allowing users to return to work and repair relationships, instead of spending all their time chasing their next fix, proponents say.
These therapies are far better for opioid users than detox and 12-step-type programs, the backers say. Those who use fentanyl and similar drugs build up a tolerance that is lost when they detox; if they relapse and return to the same high dose, they could die from a drug that’s up to 100 times more potent than morphine.
Still, detox centres and residential treatment programs remain preferred routes for many users and their families.
After commissioning a review of mental health and addiction services in Alberta, the NDP government is opening nearly 50 detox beds for adults in Lethbridge, Red Deer and Medicine Hat, with three new beds for youth in Calgary.
“We found there was a lot of concern about addiction support and the availability of detox beds within our province,” said Brandy Payne, associate minister of health. “We’ve gone through and identified key areas where we can have some extra beds to come online to address the fentanyl crisis.”