Application to maintain opioid therapy denied

Changes by province are minor and impact on patients minimal, judge rules

An Alberta court has denied an application that would have forced the province to continue providing injectable opioid agonist treatment (IOAT) at two government-funded clinics slated to shutter next month amid an ongoing lawsuit.

Court of Queen's Bench Justice Grant Dunlop ruled planned changes by the UCP government, and their effect on 11 severe opioid use disorder patients who launched a legal challenge, “will be minor.”

“While there is an argument to be made that those changes will breach one or more of the plaintiffs' charter rights, the plaintiffs have not established that they will suffer irreparable harm as a result of those changes,” Dunlop wrote in his Feb. 25 ruling.

To grant an injunction that temporarily halts the UCP government's changes would have also caused “irreparable” harm to the public interest and outweigh any possible harms to the patients, Dunlop stated.

The government said it would transition all IOAT patients to Opioid Dependency Program (ODP) clinics in Calgary and Edmonton, where they would continue receiving injectable hydromorphone and “wraparound psychosocial and health supports.”

Dunlop noted in his ruling it was unclear which wraparound services would be offered at ODP clinics, particularly related to primary care. But he said “uncertainty regarding future action is a common feature in injunction cases.”

He said it's clear the province plans to offer a full range of supports, tailored to client needs.

Funding has yet to be allocated to this alternative service.

“While any change carries a risk, I find that the risk to the plaintiffs of the province's planned changes is small,” Dunlop wrote. “Psychosocial supports will continue, but on a reduced scale and some primary care will no longer be provided on site in which case referrals will be made.”

Plaintiff Shane Monette, who is an IOAT client at the Edmonton clinic, said the decision has left him “confused” and “worried” for other patients.

“IOAT wasn't necessarily for everyone. It was for the end-of-theline people who have tried everything and nothing has worked,” said Monette. “They need something to save their life — either they are going to live or die.”

Since joining the program a year and a half ago, Monette has been sober from street drugs. Staff and fellow patients have become like family to him.

But vague details surrounding administration and funding for future service has left clients in a precarious situation, he said, adding the government's plans appear to be “far from perfect.”

“My worst scenario or thought is that it's all a facade,” he said.

“The lawsuit has been the hope. Everything else has been a mystery or a letdown or nothing at all.”

During the Feb. 10 virtual hearing, Edmonton lawyer Avnish Nanda, who represents the patients, argued the pending closure of IOAT clinics in Calgary and Edmonton on March 31 would lead to “adverse health effects,” including the return to street opioid use and possible death.

Dunlop said evidence related to the risks of terminating IOAT completely was “not relevant” because of the province's proposed alternative treatment model.

He also questioned why patients might resort to harmful street drugs.

“In the absence of an explanation why anyone would choose an expensive, potentially impure street opioid over a free, pharmaceutical grade one, I do not accept that the changes planned by the province will cause anyone to return to street opioid use,” Dunlop wrote.

Nanda rejected this statement from Dunlop.

He said severe opioid use disorder, and associated psychological and medical conditions, makes people act in ways that don't appear “rational” to those who don't have the disorder.

“I think there was a gap in understanding about what the experiences are of folks who live with severe opioid use disorder in Alberta,” said Nanda.

Monette said there are many reasons people return to street drugs, including the cost, availability and power of fentanyl compared to hydromorphone and stigma faced by health-care professionals.

Kassandra Kitz, press secretary to Associate Minister of Mental Health and Addictions Jason Luan, said in a statement they are “pleased that Justice Dunlop and the Court of the Queen's Bench agrees with Alberta's position and has chosen to dismiss the plaintiff 's claim in this matter.”

Kitz also drew attention to a statement by Dunlop that reads: “None of the plaintiffs will suffer any serious harm from the changes planned by the province.

“The evidence does not establish a high probability that the changes will cause death or serious health consequences for any of the plaintiffs.”

A coalition of organizations addressing drug-related issues in Canada said the decision will impact the health and safety of vulnerable individuals.

“(The ruling) relied on an incomplete understanding of opioid use disorder and a lack of literacy around substance use, addiction, and the lives of people who use drugs,” reads a joint statement, released by the Canadian Association of People Who Use Drugs, Canadian Drug Policy Coalition, Friends of Medicare, Moms Stop the Harm and HIV Legal Network on Friday.