Addressing the drug poisoning crisis: A call for evidence-based and inclusive policy responses in Alberta

The drug toxicity crisis is a persistent and escalating public health emergency. More than 36,000 Canadians have died due to drug toxicity since 2016. The toll on Albertans has been profound, with record high deaths reported in 2023, despite increased investment in recovery-oriented approaches.

The O'Brien Institute is committed to advancing evidence-based policy responses that address complex public health challenges and promote health equity. Recognizing the limitations of a one-size-fits-all solution to the drug toxicity crisis, it is our stance that recovery-focused interventions inadequately address the diverse needs of people who use drugs (PWUD). Given the magnitude, and increasing complexity of the drug toxicity crisis, it is imperative to invest in a full continuum of supports, prioritizing evidence-based harm reduction interventions.

The reasons behind the drug crisis are complex, shaped by changes in the drug landscape over the past 40 years. The initial wave started when there was an excessive prescription of strong pain medications in the late 1990s to early 2000s, leading to stricter regulations on prescribing. Unfortunately, the lack of safe alternatives meant that many PWUD had to turn to risky options, often to manage pain. In the years that followed, street drugs became more dangerous, creating new health challenges.

Alberta's healthcare system continues to experience concerning trends due to this crisis.

• Emergency Medical Services (EMS) responses to opioid-related events surged from 4,207 in 2018 to 8,865 in 2023, reflecting a 111 per cent increase.
• Analysis of medical history from Jan. to Sept. 2023 for individuals who tragically passed away reveals worrying patterns. For non-pharmaceutical opioids within the last 30 days of death:
  • 74 per cent had at least one health-system interaction.
  • 45 per cent had a substance-related visit.
  • 28 per cent had a substance use Emergency Department visit.
• For pharmaceutical-grade opioids within the last 30 days of death:
  • 85 per cent had at least one health system interaction.
• Between 2020 and 2023:
  • Emergency room visits due to opioid use increased by 13 per cent.
  • Hospitalizations related to opioids rose by 5 per cent.

These statistics highlight the inadequacy of our current health and care system in meeting the diverse needs of PWUD. Individuals are actively seeking varying degrees of medical support, yet our healthcare system is consistently missing opportunities for sustained, meaningful engagement to prevent drug-related deaths.

There are significant consequences for Albertans from drug toxicity. Harm from drug poisoning can happen through both prescribed medications and an unregulated drug supply. Additionally, non-fatal overdoses can result in lasting health issues such as respiratory problems, muscle breakdown, and brain injuries. The prevalence of harms is on the rise, requiring immediate attention. Effective solutions need to be based on solid research evidence to address these escalating challenges.

The growing case for comprehensive harm reduction strategies

Across Canada, various policies have been put in place to tackle the opioid crisis. Some jurisdictions have adopted measures that encompass recovery alternatives along with harm reduction strategies, such as supervised consumption clinics (SCS), drug testing tools, and access to a safe drug supply. However, Alberta's response has primarily leaned towards investing in recovery options, particularly residential addiction treatment beds, without striking a well-rounded balance that includes ample support for harm reduction. Experts in substance use and advocates for harm reduction point out that the scientific justifications behind these decisions lack robust methodology and peer review.

As overdoses and fatalities continue to rise, it becomes evident that a sole emphasis on institutionalized care falls short in addressing a significant contributor to drug-related health issues—the tainted drug supply. A more comprehensive policy approach is essential to combat the escalating challenges posed by the crisis.

Evidence to support the efficacy of harm reduction options continues to grow. 

• An evaluation of a safer opioid supply program in London, Ontario:
  • Demonstrated reduced use of unregulated drugs and decreased overdoses for participants after one year of access.
  • Reported 76 per cent of participants experiencing improvement in physical health and 56 per cent in mental health.
  • Noted reductions in emergency room visits and hospital admissions, including for infectious complications.
• A local study published in 2023 (involving O’Brien Institute members):
  • Showed that access to harm reduction services, including SCS, led to significant healthcare cost avoidance.
  • Diverted people away from emergency departments.
• A 2023 analysis of police crime and social disorder data in New York City around 19 harm reduction clinics:
  • Showed no significant changes in violent or property crimes, 911 calls, or calls regarding drug use.
  • Noted a significant decline in arrests for drug possession.

Credible research evidence shows that harm reduction measures can reduce costs, improve health outcomes and reduce public drug use, and calls to emergency services. Harm reduction measures can also provide an opportunity for people who have been excluded from mainstream services to begin to rebuild trust and relationships with healthcare professionals. Harm reduction services act as a pathway to housing, mental health supports, primary care, and different modalities of addiction treatment. 

Decriminalization done right is a crucial step in addressing the opioid overdose crisis from a public health perspective. Criminalizing drug use fails to tackle its root causes and worsens the stigma surrounding it. Substance use often stems from complex trauma, not a lifestyle choice. Shifting toward drug decriminalization acknowledges it as a complex health issue, necessitating compassionate, evidence-based interventions. This approach allows resources to be redirected to public health initiatives, emphasizing harm reduction, treatment, and support services. Decriminalization eases the burden on the criminal justice system, resulting in significant cost savings and reducing stigma. It encourages individuals with substance use issues to seek help without fearing incarceration, fostering a society prioritizing public health and offering empathetic support to those affected.

Our response to the drug toxicity crisis must consider equity-deserving communities who are overrepresented, including people experiencing homelessness and housing precarity, the 2SLGBTQIA+ communities, youth and young adults, Indigenous communities and residential school survivors, and PWUD in sexualized contexts. Many of these people are survivors of childhood trauma and have experienced varying degrees of harm within our health and social care systems.

We call on the government of Alberta expand the number of SCS clinics and for the addition of safe supply programs and drug testing equipment across the province. We also ask for authentic and meaningful inclusion of PWUD in policy discussions. Without these measures, Albertans will continue to die in record numbers.

Addressing the drug toxicity requires an evidence-based approach to save the lives of Albertans. Together, we must work towards a future where policies are based on research evidence and compassion.

Authors

Dr. Jennifer Jackson, PhD, RN

Assistant Professor, Dean's Office – Nursing, University of Calgary

Dr. Bonnie Larson, MD, MA (Anth), CCFP (AM), DTM&H

Enhanced Skills Program Director, Health Equity, Cumming School of Medicine

Dr Katrina Milaney, PhD

O’Brien Institute for Public Health member

Caitlin Stokvis, MSW

Grad Assistant-Teaching, Community Rehab Disability Study, Cumming School of Medicine