COVID-19 likely to blame for jump in overdoses

Government must embrace science to tackle our other health crisis, write Elaine Hyshka and Hakique Virani.

Even more Albertans have died from overdose than from COVID-19 this year. In the first 10 months of 2020, 904 Albertans died from opioid poisoning, a 66-per-cent increase year-over-year.

Unlike most political leaders, Premier Jason Kenney hasn't shied away from speaking frequently about overdose. He announced these devastating numbers himself last week. Unfortunately, the premier erred in his explanation of what is causing this dramatic increase in overdose deaths. For Alberta to effectively address this ongoing public health catastrophe, we have to be clear on what is driving it.

The premier implied that over 1,000 opioid-dependency patients were cut off treatment when Alberta Health Services temporarily “suspended” clinic operations in March. However, this statistic referred only to in-person visits, and did not account for the fact that patients continued to receive care virtually. Indeed, data from the new provincial substance-use surveillance dashboard show that the number of Albertans treated with the medications prescribed by the “suspended” clinics has been remarkably stable throughout 2020.

It is true that abstinencebased residential treatment capacity has been more constrained during the pandemic. However, these programs alone are not typically recommended for opioid-use disorder. Opioid dependency medications are far more effective at reducing all-cause mortality and facilitating long-term recovery, and are the national standard of care.

Premier Kenney also cited anecdotal reports blaming the recent spike in overdoses on the Canada Emergency Response Benefit (CERB). It is very unlikely that CERB is a major driver. The overdose spike of 2020 was well underway (up 43 per cent in March compared to February) by the time the first CERB payments flowed in mid-april. In fact, the increase in deaths from March to April (26 per cent) was less than the month-overmonth increase before CERB was even introduced.

So what is causing the rise in overdoses during COVID-19?

The most plausible explanation, according to national and international authorities, is that COVID-19 has disrupted regular drug-trafficking routes, forcing producers and sellers to find new ways to make, mix and transport drugs. As a result, illegal drug contents and concentrations have become even more volatile, contaminated, and toxic. This theory is consistent with toxicology lab results documenting more fentanyl analogs and higher concentrations of opioids since the pandemic began. It also would explain why the United States is experiencing a similar increase in overdose deaths this year. Compounding supply issues, physical distancing and social isolation can lead to more people using alone with no one to call for help if they overdose.

Albertans are attending supervised consumption sites (SCS) far less frequently since the start of COVID-19. SCS visits declined from over 114,000 in the first quarter of 2020 to under 41,000 in the second to under 35,000 in the third.

As more Albertans die from overdose than ever before, it is concerning that the provincial government has decreased its support for interventions proven to save lives. In August, Alberta Health closed the province's largest and busiest SCS in Lethbridge, replacing it with a small mobile unit that can accommodate far fewer clients. With funding set to expire in March 2021, the fate of this and the six other SCSS remains unclear. Injectable opioid agonist treatment clinics in Calgary and Edmonton are also being shuttered even though evidence shows this treatment prevents death, improves quality of life, and reduces illegal drug use and crime. Patients are suing the government over this decision, arguing it violates fundamental Charter rights.

Facing a situation that clearly demands innovation, the provincial government abruptly shelved a novel virtual supervised consumption service for people who use drugs at home alone, earlier this year.

Further, while three other provinces have accepted federal funding to pilot structured “safer supply” programs that provide at-risk individuals pharmaceutical alternatives to illegal street drugs, the Alberta government has indicated it has no intention of testing this strategy here. This refusal is misguided. With the dramatic shift toward a more toxic illegal drug market over the past five years, it is becoming clear that conventional treatment and harm-reduction strategies, even if fully implemented, may be insufficient to substantially reduce deaths at the population level.

The global pandemic has reminded us that public-health emergencies are most effectively tackled by courageous leaders who embrace science and innovation, and who protect society's most vulnerable. Until we are willing to do exactly those things to solve our drug overdose emergency, the lives of thousands of Albertans will hang in the balance.

Dr. Elaine Hyshka is an assistant professor in the University of Alberta's School of Public Health. Dr. Hakique Virani is a public health and preventive medicine and addiction medicine specialist and associate clinical professor in the University of Alberta's faculty of medicine and dentistry.