Loss of funding for intensive opioid therapy program will have fatal consequences, critics warn

The government's plan to close clinics in Edmonton and Calgary offering what is considered a last-resort treatment for opioid addiction will put lives at risk, advocates warned in an open letter to the province Wednesday.

In a letter addressed to Premier Jason Kenney, more than 600 doctors, frontline workers and patient advocates call on the province to maintain funding for Alberta's two injectable opioid agonist treatment (iOAT) facilities, one in Edmonton and the other in Calgary.

"At this time more than any before, we must offer all evidence-based treatments to patients," the letter states. 

The opioid crisis continues to exact a disproportionate toll on Alberta, the signatories warned, and the ongoing toll of the pandemic — including the increased presence of contaminated street drugs — has left addicts especially vulnerable.   

"Alberta remains one of the hardest-hit provinces, with close to two people dying daily as a result of accidental opioid poisoning. And reports of increasing EMS calls for overdose and the re-emergence of carfentanil in the drug supply make us concerned that this crisis has worsened over recent months," the letter states.

"Those who are currently benefiting from this treatment will be forced off of it in the coming months and many of these individuals may suffer severe adverse outcomes as a result." 

The clinics were set up under a two-year pilot program announced by the previous NDP government in late 2017. The Calgary clinic opened in October 2018, and the Edmonton clinic opened in May 2019. Together, the facilities once served more than 200 patients, clinic managers said.

A $14-million grant for the program was set to expire in March 2020, but the UCP government elected last year renewed it for another year to transition patients to other forms of treatment.

The clinics are set to close next spring. Funding ends March 31.

The government has no plans to extend the pilot and Kenney has suggested that the harm reduction model only serves to condemn addicts to an endless cycle of substance abuse.

'The rug pulled out'

Intended to help those suffering from opioid dependence, iOAT treatment delivers pharmaceutical-grade opioids via a syringe, rather than pills.

Patients inject hydromorphone three times daily under the supervision of a nurse. Clients enrolled in the treatment program are offered psychological, financial and housing supports.

Injection treatment is only offered to people with severe, long term addictions when other treatments prove ineffective.

"Some of them are in a panic because they've finally been stabilized," said Dr. Krishna Balachandra, an assistant clinical professor in the University of Alberta's Department of Psychiatry.

"They've finally been able to engage into a system. They've been actually being treated with dignity and respect. 

"And now, it's sort of like having the rug pulled out from underneath them so they're feeling really unsettled, and rightfully so, very scared about the future." 

If the clinics close, the results will be dire, said Balachandra, who has been working at the Edmonton clinic since it opened.

My real concern is that without a proper program such as ours, there is going to be an increased risk of overdose deaths.- Dr. Krishna Balachandra

Balachandra said about 100 patients across the province are currently enrolled in the treatment program. Without injection treatment, patients will likely return to using street drugs and a dangerous cycle of addiction. 

For many of his patients, daily injections are the only way to keep withdrawals at bay.

"Unfortunately, this is a special population in which abstinence immediately is not an achievable goal," Balachandra said. "If we lose funding, there is a risk for them to continue using illicit opioids on the streets. 

"My real concern is that without a proper program such as ours, there is going to be an increased risk of overdose deaths."

Transitioning patients to other forms of treatment is not going smoothly, Balachandra said.

The clinics recently stopped accepting new patients and current clients have nowhere to go, he said. Treatment options are limited. 

"In preparation for the cessation of funding, we've actually begun a process of trying to see if any other health health care provider can take on this population. And the answer so far has been 'no.' 

"We have no other place to transition these patients. And it doesn't generally make sense for us to send them back to treatment for which they've already failed." 

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The decision to discontinue funding is dangerous and fiscally irresponsible, Balachandra said. The long-term cost to the health system will increase if patients "return to their old ways," he said.

At the time the two-year pilot was announced in late 2017, more than two people in Alberta were dying from opioid overdoses every day, on average.

The latest AHS statistics show moderate declines in the number of overdose deaths. On average, in the first three months of 2020, more than 11 people in Alberta died each week as a result of apparent accidental opioid poisoning.  

In the first three months of 2020, 142 Albertans died from opioid poisoning, compared to 161 in the same period last year.

But recent months have seen a concerning spike, especially in Edmonton, prompting Alberta Health Services to issue two warnings about the dangers of powerful opioids, particularly carfentanil, contaminating the street drug supply. 

In the last week of May and first week of June, carfentanil was identified in 16 deaths; 14 of them occurred in the Edmonton region.

'Orderly transition' 

In a statement, government spokesperson Steve Buick said the dissolution of the program has been carefully managed and that the treatment cost about $148,000 per individual.

"Under the terms of the pilot, the project managers are required to submit a report on the efficacy of the pilot. To date this has not happened," Buick said in the statement.

Nearly half the original patients have now been transitioned to other treatments as intended, he said.

As of Wednesday there were 29 individuals receiving iOAT in Calgary and 25 in Edmonton, he added.

"Planning is underway to transition the remaining patients to other treatments and community supports," reads the statement.

"The health care teams in the clinics and various community partners are working closely together to continue the patients' iOAT, maintain the patients' health and safety during the COVID-19 pandemic, help patients achieve positive health and quality of life outcomes and to ensure the patients receive respectful, kind and compassionate care." 

No 'zero sum game'

Critics, including physicians and members of the NDP Opposition, have expressed fears that removing funding is an ideological response against the harm reduction model — an accusation Health Minister Tyler Shandro has dismissed.

During a news conference Wednesday, Shandro rejected claims that patients would be adversely affected.  

"I really reject the idea or the premise that this is a zero-sum game," Shandro said.

"The focus of this government is to include harm reduction as a part of its strategy, but also to say that we're no longer going to be a one pillar strategy when we deal with the opioid crisis," he said. 

"We are now going to also include recovery options for Albertans and their families and making sure that this system has a focus on the full spectrum." 

Kenney said Wednesday he has not seen the letter.

He said, however, that his government is focused on a "holistic approach" to addiction treatment and the transfer of affected patients to other treatment models would be "seamless."

Kenney pointed to a recently announced $25-million investment in the construction of five addiction recovery communities throughout the province as evidence of his government's commitment to addiction care.

"Our government's focus is on a holistic approach that includes an appropriate space for harm reduction but significantly expands access to treatment and recovery services," Kenney said.

"Albertans know that facilitating addiction, as the federal government now wants to do by handing out free narcotics to addicts, is not compassion.

"A compassionate approach offers people stuck in the trap of destructive additions a path out, a way out and that's why our focus is on treatment and recovery."