Patients launch lawsuit over pending closure of Alberta opioid treatment program

Shane Monette describes his addiction to opioids as an obsession, a fatal attraction.

A survivor of childhood abuse, he began using drugs and alcohol as a teenager to mask his pain.

As years went by, he developed a $400-a-day heroin habit and was in and out of jail, committing petty crimes to feed his addiction.

Drugs became an escape from his trauma. Opioids gave him the most relief. 

His body began to break down. He developed a heart infection and was sure he would die, like so many of his friends, on the streets.

As his health began to fail, Monette desperately wanted to quit. He tried abstinence, suboxone and methadone, and spent time in a detox centre.

None of the treatments helped appease his addiction, until he became a patient at Edmonton's injectable opioid agonist treatment (iOAT) clinic. The treatment is considered a last resort for those living with the most severe opioid addictions.

Monette is among 11 Albertans struggling with substance abuse who have filed a lawsuit against the provincial government for discontinuing iOAT treatment in the province.

Clinics in Edmonton and Calgary offering the treatment are set to close next spring after the province cut their funding, which ends March 31.

The statement of claim, filed Sept. 30 in the Edmonton Court of Queen's Bench, alleges that closing the clinics infringes on patients' charter rights by putting their lives and personal security in peril. 

It also contends that denying addicts access to the "lifesaving and life-sustaining treatment" amounts to discrimination. 

The lawsuit calls on the court to halt the closures and maintain service for current and future patients. None of the allegations has been proven in court.

'People will continue to die'

"My life was saved by the iOAT program," said Monette, 38. 

"For me, fentanyl was a love affair, an obsession, bondage, a mental deadbolt that ultimately turned into a fatal attraction that destroyed everything in its path including my liver, my vital organs and ultimately could have been my life.

"iOAT changed that, it helped me maintain my life and become stable again. Without these forms of treatment people will continue to die." 

iOAT treatment delivers pharmaceutical-grade opioids via syringe, rather than pills.

Patients inject hydromorphone, a medical-grade opioid, three times daily under the supervision of a nurse. Clients enrolled in the 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.

Established by NDP

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. The Edmonton clinic opened in May 2019. Together, they once served more than 200 patients.

A $14-million grant for the program was set to expire in March 2020, but the United Conservative Party government, elected in April 2019, renewed it for another year to transition patients to other forms of treatment. The government has no plans to extend the pilot.

Premier Jason Kenney has suggested that the harm-reduction model only serves to condemn addicts to an endless cycle of substance abuse

In a statement issued Thursday, Kassandra Kitz, press secretary to Jason Luan, the associate minister of mental health and addictions, said patients are being safely transitioned out of the pilot program.  

The province said it remains confident the transitional work will be completed by the end of March 2021.

"To be clear, clients of the pilot study are able to access similar treatments through Alberta Health Services at 10 opioid dependency clinics, and more than 40 per cent of active iOAT clients have already successfully transitioned to other appropriate treatment options," Katz said in the statement to CBC News.

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The lawsuit details the lives of 11 addicts, each consumed by their own trauma. Some experienced childhood abuse and homelesness, and have cycled in and out of foster homes, prison cells and treatment facilities. Some have overdosed numerous times.

One of the plaintiffs is a former elite swimmer who became addicted to pain medication after a spine injury in his teens. Another, a Sixties Scoop survivor, was mentally and physically abused by her adoptive family. Another plaintiff survived residential school and lost his own son to a fentanyl overdose before enrolling in the program.

The statement of claim says some of the program's patients have already returned to using street drugs. 

"The plaintiffs suffer from the most severe form of opioid use disorder, which left untreated will result in serious adverse health and effects, including premature death," it says.

"To avoid an abrupt and potentially life-threatening transition from iOAT to street opioid use, some iOAT patients have resumed street opioid use in a gradual manner to safely facilitate their transition off of iOAT. In doing so, iOAT patients are exposing themselves to serious dangers associated with street opioid use, including the risk of death." 

The statement of claim was filed weeks after more than 600 doctors, frontline workers and patient advocates issued an open letter calling on the province to maintain funding for both iOAT facilities.

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. 

Edmonton lawyer Avnish Nanda, who is representing the plaintiffs pro bono, said closing the program will result in overdose deaths.

Nanda said about 100 patients are currently enrolled in the program and there is a waiting list. He said the decision to provide or deny service should be left to medical professionals. 

"How many people have to die for you to assert that your ideology is worth it?," said Nanda in a news conference Thursday. 

"Three Albertans are dying every day and even one of those Albertans can be saved by iOAT then we should allow this program to continue."

Nanda expects the case will take years to resolve but said the treatment programs need to be reinstated immediately.

He is seeking an emergency injunction that would prevent all iOAT patients from being denied the treatment until the lawsuit concludes.

"If we have any delay on this, it's possible and maybe probable that some of the plaintiffs may die."