In Alberta, a lifeline in the balance
As overdose deaths surge, province will end access to legal injectable opioids
When Susan Tierney’s son Keigan was living on the streets and in the grips of a severe opioid addiction, she would spend her nights waiting for her phone to ring, hoping to hear his voice.
“We asked him to call us once a week just so we would know he was alive, and we wouldn’t hear from him for weeks at a time,” the mother of two said from her home in Calgary.
“I can’t even explain what that feeling is like. And I would not have been a fan of or a supporter of a harm reduction program until we saw what it did for our son.”
The program that helped Keigan, 27, turn his life around was Alberta’s Injectable Opioid Agonist Therapy program, known as iOAT. It provides injectable synthetic opioids three times a day to patients in a clinical supervised setting.
The program was established by Alberta’s previous government in 2019 and includes one clinic in Edmonton and one in Calgary. It targets individuals who have been using opioids intravenously for years, sometimes decades, and requires them to have failed at least two other previous treatments or to prove that they’ve been unable to access effective treatment at all.
The provincial government has decided it won’t continue to fund the program after March 2021.
Now 11 patients who use the program are suing the provincial government on the grounds that it’s denying access to lifesaving treatment to people with a physical and mental disability, which their lawyer contends would breach the Canadian Charter of Rights and Freedoms.
“Imagine being in that state where you know something can kill you, but you have to do it because the pain is too much to manage without opioids,” said Avnis h Nanda, who is representing 11 plaintiffs in the suit. “These are folks who have such a serious medical condition that despite knowing the risks, they have no choice.”
Keigan, one of Nanda’s clients, was an aspiring football star in high school before he started using fentanyl to deal with the loss of a family member and depression resulting from a brain injury.
He never expected it would lead to him panhandling at a train station to feed his addiction, or stealing cars and ending up in the Calgary Remand Centre. He tried numerous therapies before, but would always relapse. Until he found a program that permitted him to inject opioids.
“I think that’s the key reason that I haven’t been back to jail since,” Keigan said.
Keigan credits the iOAT clinic for connecting him with mental health and addiction counsellors and helping him find housing. He’s transitioned from injecting opioids to taking them orally.
Most importantly, he’s rebuilt his relationship with his family. He’s grateful he was present to meet his nephew, who was recently born.
“Getting to meet him and be in his life, I never thought that I’d be able to do something like that again,” Keigan said.
The government’s plan to end the program comes after Alberta recorded the most opioid overdose deaths ever in the second quarter of 2020. Between April and June, 301 people died of opioid overdoses in Alberta, compared to 142 in 2020’s first quarter.
Elaine Hyshka, an assistant professor at the University of Alberta, said the provincial government has shown a willingness to invest in traditional treatments such as short-term residential treatment and detox centres, but it has opposed supporting harm reduction services such as safe supply of prescription opioids.
She said the opioid crisis, which has killed close to 20,000 Canadians since 2016, requires a different approach.
“It’s totally starkly unprecedented, we’ve never seen this many people dying this before,” Hyshka said. “So just making investments in things we’ve had for a long time is not the solution.
“Unfortunately, what we’re seeing in Alberta is a real reluctance to innovate or try new things when it comes to opioids and overdose.”
The first-line treatment for people addicted to opioids is Opioid Agonist Therapy, which provides synthetic opioids such as methadone and suboxone to wean people off street opioids or prescription drugs like Percocet.
But people who have been using opioids intravenously for years often have a very high tolerance, making traditional treatments such as oral doses of methadone ineffective for some.
“What iOAT does is it offers a chance for us to engage that very treatment-resistant or hard to engage population,” said Krishna Balachandra, an assistant clinical professor at the University of Alberta who works at the Edmonton clinic.
He fears his patients will have no choice but to scour the streets for fentanyl when the program ends. The drug comes with a high risk of overdose, even for seasoned users.
“It’s going to be potentially devastating,” Balachandra said. “We’ve finally stabilized a very complicated population, and there seems to be no viable or practical option to transition them to lower forms of service at this point.”
The program serves a small subset of patients, about 100 people split between Edmonton and Calgary. Besides Alberta, these types of programs exist in B.C. and Ontario. These are the three provinces hardest hit by the opioid crisis.
“There’s no doubt the numbers would be much higher if we had the capacity to increase access,” said Robert Tanguay, a clinical assistant professor at the University of Calgary. “We’re always at full capacity.”
Tanguay and Balachandra both emphasized that this is a small but vulnerable group of people with extremely complex needs; the clinics see a high incidence of hepatitis and HIV infection due to intravenous use, as well as other issues such as homelessness, clients engaged in sex work and people with severe psychological trauma.
“It’s not like we can shove them into a detox centre and in 18 days they’re going to be cured of their addiction,” Tanguay said. “That just shows the lack of understanding of some of the most difficult and complex patients.”
In a statement, Alberta’s United Conservative Party government said the program was a pilot study and the previous government left no plan for iOAT’s continued operation.