By Geoff Russ, September 27, 2022
British Columbia and Alberta have been hit hard by the opioid crisis, and both will have new premiers who must try to combat it. David Eby and Danielle Smith are the purported frontrunners to succeed John Horgan and Jason Kenney, respectively. As such, they may inherit two very different systems designed to accomplish that goal.
Alberta’s strategy emphasizes personal recovery and expanded treatment facilities, with thousands of new spaces for addicts beginning their recovery. By contrast, BC has embraced harm reduction, involving the distribution of pharmaceutical alternatives to addicts in place of toxic street drugs, usually referred to as “safe supply.”
Like so many other issues, BC and Alberta are once again the tale of two provinces when it comes to the opioid epidemic. Since January, Alberta has seen the number of overdoses reduced by significant margins. In BC, the numbers have kept rising with no end in sight, even as the province doubles down on its strategy. Indeed, BC is no longer an active theatre of the War on Drugs under its current government. And the province’s NDP government has long supported decriminalizing the possession of small amounts of drugs.
“We’re leading the country on prescribed safer supply, decriminalizing people who use drugs, and have allowed registered nurses to prescribe medications for opioid-use disorder,” says Sheila Malcolmson, Minister of Addictions and Mental Health for BC’s New Democratic Party (NDP) government. “We won’t stop working until all British Columbians can get the help they need, when they need it.”
Premier John Horgan had previously urged Ottawa to develop a national plan to change its policies regarding possession of illegal substances for personal use. “The province of British Columbia offers its support and encouragement to the government of Canada to take urgent, necessary action on this matter to save lives,” Horgan wrote in a letter to Ottawa in 2020.
By early next year, BC will become the first province to receive a three-year exemption from Ottawa that decriminalizes possessing small amounts of illegal drugs. Third-party activist groups have also been controversially allowed to distribute heroin, cocaine, and other drugs to addicts without prosecution. Government-supplied heroin has also been floated as a future possibility.
On August 12, 2022, the BC government announced a $430 million investment to escalate its response to what it calls the “toxic drug crisis.” A statement from the BC Ministry of Addictions and Mental Health notes: “Separating people from the toxic, unpredictable illicit drug supply is an important step to preventing drug poisonings and helping people stabilize their lives.”
BC is the first province to offer prescriptions of “safe supply,” a term that describes otherwise illegal drugs produced and distributed under governmental supervision, such as fentanyl patches.
Marshall Smith is chief of staff for Mike Ellis, Associate Minister of Mental Health and Addictions for Alberta’s United Conservative Party (UCP) government. He says both provinces have embraced different ideologies to combat the opioid crisis, and he is not wrong.
“One is a concept of simply reducing harm which is a relatively low bar,” says Smith. “There is another view that says no, addiction is a chronic, relapsing healthcare condition, and with the right treatment, recovery should be possible.”
Smith says Alberta subscribes to the latter, calling it the “recovery oriented system of care.” More affectionately called the “Alberta model,” it involves heavy government investment to streamline access to expanded, government-funded treatment for addiction. According to Smith, part of the Alberta government’s approach is believing people will enter treatment to “regain their life” if given the option.
Most narcotics remain illegal in Alberta, without a prescription. Alberta police now offer treatment to persons caught using illegal drugs almost immediately after being apprehended. Five recovery (or “therapeutic”) communities, designed to host long-term residential care, are being built across Alberta, each costing $5 million. One community in Lethbridge hosts 50 beds, while one on the Blood Reserve has 75 beds.
“Some of our people that have been living on the streets for several years, they need to learn how to live again,” says Minister Ellis.
Every participant inside the communities dictates the pace of their treatment, like setting personal goals for their recovery process. Aside from becoming drug-free, recovery community goals include participants reflecting on their behaviour, and leaving employed or enrolled in schools, or job training. Also present are “recovery coaches,” or people with lived experience. They go into the communities and engage with people to help them in their recovery.
In total, Alberta has spent $140 million to fund more than 8000 new annual treatment, detox and recovery spaces located throughout Alberta, including the therapeutic communities. Addiction treatment is free for any Albertan, and voluntary. Meanwhile, while BC’s government says it has also created new treatment and recovery beds, there are just 3261 in total.
Alberta’s government had rejected a safe supply system in 2019. Yet a committee was called by the Alberta government last December to study the merits of safe supply. It ultimately did not recommend it in its final report that was released in June. Controversy surrounded the committee, and critics decried it as biased and insufficient. Alberta, however, is staying the course.
“Our model is based on prevention, intervention, treatment, and recovery, which is different from BC, which is prevention, harm reduction, enforcement, and treatment,” says Smith.
Born in BC, Smith is not shy to criticize his home-province’s response to the opioid crisis, which he says are ineffective. “Our numbers are plunging down, BC’s are continuing to go up, and that is clear, it is not in dispute,” says Smith.
In January 2020, 48 people died due to substance-related deaths in Alberta. This increased to 131 in January 2021. Indeed, Alberta suffered its worst year for drug-related deaths in 2021, with 1616 people losing their lives. Meanwhile, 174 people died in December of that same year, the highest counts since Alberta began collecting such data in 2016.
However, the tide in Alberta appears to be slowly turning this year. In July 2022, 92 people died in Alberta. Although still well-above the pre-pandemic average, it is a 47 percent decrease since the December peak last year. In that same timeframe, Calgary and Edmonton have seen respective 48 percent and 42 percent decreases.
In contrast, hope for the future is rarely present when Vancouverites think or talk about the opioid crisis these days. Despite the BC government’s initiatives, 1176 deaths in 2020 made it the province’s deadliest year for overdoses. That is, until the next year, when 2224 people died from overdoses across the province.
The pandemic’s wind-down has not reversed BC’s rising death toll. An entire zip code of Vancouver now hosts tent cities clustered around a supervised drug injection and safe supply distribution site. By June of this year, at least 1095 British Columbians had passed away from drug overdoses. 2022 is projected to set another record for overdose-related deaths in BC.
Malcolmson has come under criticism for her office’s failure to improve the situation.
“Despite our best efforts, the street drug supply has become increasingly toxic over the last six years and even more so during the COVID-19 pandemic,” says Malcolmson, who says progress was made prior to the pandemic. “[I]ncreasing illicit drug toxicity has outstripped our unprecedented addition of new overdose prevention services.”
BC has also funded the mass-distribution of Naloxone kits. Naloxone is a substance commonly used to prevent overdoses. Overdose prevention centres are being expanded across BC that offer “observed inhalation services” in hard-hit communities. Around 3.1 million people visited these sites between January 2017 and June 2022. Over 22,000 overdoses were successfully responded to, and the number of sites has increased from one supervised site in 2016 to 42 today.
The Alberta government has been criticized for freezing funding to supervised drug injection sites. Ellis says he is not opposed to them, but that they are just part of the government’s solution.
“I’m not opposed to supervised consumption sites or overdose prevention sites. It is part of the continuum of care,” says Ellis. “It is just not the solution to a very, very complex problem.”
With Alberta Premier Jason Kenney’s resignation, how the province’s response to the opioid crisis will change under his successor, Danielle Smith, remains to be seen. For now, the UCP government remains opposed to safe supply, and will stick to its “Alberta” model. Nonetheless, Ellis says his strategy is flexible:
“I’m optimistic that we’re heading in the right direction, but I’m glad that we’ve been able to provide hope to other restrictions that detox treatment and recovery is the right approach in helping people with substance use disorder.”
Horgan stepping down as premier has also opened up other possible approaches to deal with the opioid crisis in the province. His likely successor, David Eby, proposed involuntary treatment for addicts last summer during his leadership campaign. Controversial as those plans were, it was a break from his party’s drug policy in BC. If the status quo is any indication, following through on that proposal if he becomes premier may just be the BC government’s first firm step in the right direction.
Geoff Russ is a Reporting Fellow with the Hub. He is based in Vancouver.