Why an Alberta lawyer is pushing back on part of the province's new addictions strategy

This story is part of a series called The Way Out: Addiction in Alberta. Join the discussion, or read more about the series here.

WARNING | This story contains details of drug use.

At 5:55 p.m. every day, 21-year-old Ophelia Black begins the elaborate process of injecting a prescription opioid into her arm. 

First, she calls the National Overdose Response Service (NORS) on her mother's cellphone. 

"They all know me now."  

She sanitizes her hands, puts on latex gloves, fills up a needle with hydromorphone (an opioid like fentanyl but less potent) and then injects it into her arm. 

Once she can confirm she has not overdosed, she thanks the NORS team and proceeds with her evening.

Black will do this again either before bed or in the middle of the night, and then again at 9 a.m. 

"I used to need it six times a day, but I've cut back to three," she says with pride.

For Black, who has struggled with depression since she was a child and, until two years ago, was hooked on fentanyl after years of physical and sexual abuse, she says this is success.

"In the two years that I have had this prescription, I have never had a single infection. Because of how careful I am. I have never overdosed."

But now she can't do this anymore. The provincial government has changed the rules around who can prescribe high-potency, short-acting opioids like the hydromorphone she uses.

So Black has sued the province. Her lawyer, Avnish Nanda, will argue for an emergency injunction in a Calgary courtroom Tuesday morning.

Nanda says he will argue Black should be allowed to continue with her prescription while the lawsuit is being decided in the courts.

He says that without it, she may be forced to buy drugs on the streets to avoid withdrawal.

If the injunction is granted, it would not apply to other people with prescriptions like hers.

Narcotics Transition Services

This change to how opioids are prescribed was quietly announced in October 2022, when the provincial government amended its narcotic transition services (NTS). 

The provincial government will now centralize the care of people with severe opioid addictions in opioid dependency programs (ODP), which focus on tapering people off of "high-potency" opioids like what Black is on.

Calgary's program is at the Sheldon M. Chumir Health Centre. Edmonton's program is at the 106th Street Clinic, and there are others across the province.

This will leave Black with two options: first, she can transition to the ODP, where her intake of hydromorphone will be monitored and ultimately tapered.  

She says this option is unrealistic because it would require her to take lengthy transit rides to the clinic multiple times a day from her home in the far southeast corner of Calgary. Two of her injections happen when the ODP is closed.

Or, she can transition to other drugs like methadone or suboxone. These are widely accepted opioid replacement drugs often used to help wean those addicted off of their street drugs. 

WATCH | Ophelia Black describes what she uses to safely inject her prescription:

Ophelia Black explains how she administers her prescription opioid

2 years ago

Duration 1:34

For two years, Ophelia Black, who has severe opioid use disorder, has been administering the drug hydromorphone to herself multiple times a day.

Black says she has tried those and they did not work for her.

"Right now, this is what's most effective for me. But I've tried all of it. This was the last resort. They don't give out a prescription like this, you know, like the first time. This is the last resort."

Black says she would like to reduce her opioid use but she isn't ready.

"Even if, let's say, hypothetically, in the future, I am able to go off of my prescription completely. Even if that was true, dragging me off of it, kicking and screaming when I'm not ready, that's not the way to accomplish that."

The Alberta model

This change is part of the provincial government's shift away from some harm-reduction approaches to the opioid crisis and toward what it calls a recovery model.

While harm reduction focuses, in part, on providing safe access to drugs for those who use them, recovery steers people away from using drugs altogether. 

Minister of Mental Health and Addiction Nicholas Milliken says he won't comment on Black's lawsuit because it is before the courts. 

But he says the drugs being used by some individuals can be dangerous. 

"It's good to make sure that individuals who are using them would have the opportunity to do so in a medicalized environment where they would have a lot of opportunities to receive pathways toward treatment and recovery," Milliken said in an interview.

The UCP government is concerned about these prescription opioids being sold on the streets, Milliken said, which is referred to as "diversion."

"We'll see them being traded or sold on illegal markets. You'll end up with hydromorphone in the hands of individuals who shouldn't have it," he said.

"That can then lead to, obviously, issues on public safety, and of course we're committed to ensuring that individuals who require the services get the services, but we also have to balance that with making sure that we keep our community safe."

Black says she would never sell her prescription because she needs every milligram, and now that street-sourced opioids are so cheap, it wouldn't even be worth it. 

She says she'd willingly take a weekly drug test to prove she'd taken her medication.

A 'death sentence' for patients

According to the Ministry of Mental Health and Addictions, an estimated 350 patients like Black are affected by the changes outlined in the NTS document.

A prescriber we are calling "Jane" treats a number of them. We are not using her real name because she fears reprisal for criticizing the provincial government.

She prescribes drugs like hydromorphone (in combination with other drugs) to a number of patients with opioid use disorder, the majority of whom are Indigenous and homeless. 

"It was really, really sickening because we know the harms of deprescribing, and it's destabilizing. It's like forced tapering," she said.

"It's a death sentence for people. It's going to force them to go back to use fentanyl."

Jane says that over the two years she's been able to prescribe these drugs, she has helped stabilize her patients addicted to fentanyl.

"For some of them, it's as simple as they want to reduce the overdose risk, and that's it. They don't want to die." 

Once they've stabilized on the opioids she prescribes, she says they can move on to their goals.  

"They want to connect with the social circle again, or if they get on and it's good, they'll bring me like their partner the next time or they'll bring like their children if their child is also using fentanyl. So there's all of these goals in the back of their head."

It's as simple as they want to reduce the overdose risk, and that's it. They don't want to die.- "Jane," a prescriber

Now, one by one, she is telling them she can no longer prescribe these drugs. She has offered to help them transition to the ODP in Calgary.

No one has wanted to because of how far it is from where they live and because it is something new and unfamiliar, she says.

So, she's trying to taper them off the drugs and on to others. 

It's not going well. 

She says her patients have already told her they'll return to buying their drugs on the streets.

Jane says perhaps the most upsetting part of the conversations she's having with her patients is how unsurprised they all are.

"And I thought that really hurt, that they weren't surprised. Because they've been let down so often."