More than 900 Albertans died from opioid poisoning in first 10 months of 2020
Pandemic interfered with people's access to treatment and counselling
New data released by the Alberta government Friday shows the province is on track for a record-breaking number of opioid deaths in 2020.
Information published on a new government substance abuse surveillance website also shows how profoundly the COVID-19 pandemic has affected people's ability to manage their addictions.
In the first 10 months of 2020, 904 people died of opioid poisoning in Alberta — more than the total in any year since tracking began in 2016.
In July, Alberta had a record high 142 opioid-related deaths. By October, the monthly death toll had decreased to 94, which is still higher than the average before the pandemic reached Alberta in March.
Associate Minister of Mental Health and Addictions Jason Luan said his heart sank when he saw the most recent numbers.
"Every life lost is too many," he said. "Those are the people who are family members, colleagues, members of our community. It's awful."
Premier Jason Kenney said Friday he believes public health restrictions the government used to manage the earlier days of the pandemic are at least partly to blame for such "unintended consequences."
"Those decisions, they weigh heavily on me and everyone around our cabinet table," he said.
He said Indigenous people have been particularly susceptible to overdose deaths this year.
Alberta is no outlier — the phenomenon has been seen across the country.
Before the virus that causes COVID-19 arrived in the province, the government data shows that the grip of the opioid crisis was loosening. In 2019, the number of fatal overdoses began to decrease, and the number of emergency medical services calls involving opioids was dropping.
In March, those downward trends reversed sharply. At the same time, attendance at supervised consumption sites in Edmonton, Calgary, Grande Prairie, Lethbridge and Red Deer began to plummet. Those services were temporarily suspended and then subject to occupancy limits during the first wave of the pandemic in the spring.
Kenney also placed blame on the federal government's Canada emergency response benefit (CERB). He said some people with addictions used the money to buy illicit drugs. But he also said people need a basic income to survive, and isn't sure how a government could have stopped anyone from using the benefit for drugs.
Dr. Hakique Virani, an Edmonton public health specialist who works with marginalized groups, said there is no evidence basic income supports like CERB lead to more fatal overdoses.
"We've got really good research that shows that when people who use drugs are offered basic income, they make really good choices about how to use that income in situations that are not stressful," he said. "The narrative that we have to protect people from themselves is a particularly harmful one."
Pandemic restrictions limited addictions help
Public health guidelines to keep people apart also limited the number of people who could enrol in in-patient addictions recovery programs. Alberta's chief medical health officer later approved unique pandemic operating rules for these facilities.
People enrolled in harm reduction programs and receiving prescribed opioid replacement therapies stopped coming to the clinics and taking their medication, and their use of illegal street drugs jumped, according to the results of drug tests from people enrolled in the programs.
Initially, public health rules prevented support groups like Narcotics Anonymous and Alcoholics Anonymous from holding indoor meetings. Those meetings are now allowed, with masks and physical distancing in place.
Luan said services have adapted, offering virtual therapy and counselling sessions around the clock.
Alberta's chief medical officer of health, Dr. Deena Hinshaw, said it's "very difficult" to know what drove an increased number of opioid deaths in 2020. Although some services were closed or restricted in March and April, the most recent set of public health orders are designed to allow access to drug treatment and recover services, she said.
But Prof. Elaine Hyshka, a researcher in the University of Alberta's School of Public Health, said there's no evidence public health restrictions caused an increased number of deaths this year.
What's killing people, she says, is a fluctuating and increasingly toxic supply of street drugs — a premise the Alberta government disputes.
Surveillance data from Ontario and B.C. shows street drugs are appearing with higher, and more deadly, concentrations of fentanyl, she said.
Dr. Virani cited similar evidence, saying medical examiners are finding higher concentrations of drugs in people who have succumbed to poisoning.
Both experts said people using substances alone during the pandemic increases their risk of dying from an overdose.
Hyshka said Alberta should be piloting safe, legal drug supply programs for people who don't respond to more conventional treatments.
"Unless we're willing to try new things, I don't see how we're going to get out of this situation," she said in an interview. "The fundamentals of the illegal drug market have just changed permanently and we're losing so many people because of it, and we just need to rethink our whole approach, unfortunately."
The premier has previously criticized harm reduction approaches as "helping addicts inject poison into their bodies," and said supervised consumption sites are no long-term solution.
Lorna Thomas, co-founder of the organization Moms Stop the Harm, said the government's abstinence-only approach to drug treatment is harmful. Thomas, whose son took his own life while dependent on drugs, said the government needs to keep people alive while it works to increase the number and variety of treatment programs across the province.
More information now online
The government has pledged $140 million for mental health and addictions programs during its four-year mandate, including $40 million for tackling opioid addictions.
Some of the funding has gone to community groups that work with specific demographics, such as seniors, Indigenous people and new immigrants.
Now that COVID-19 cases have risen across Alberta, prompting four weeks of stricter limits on gatherings during the holiday season, Luan said he hopes the changes they've made since spring will reduce any second wave of substance abuse deaths.
With the Friday launch of the Alberta Substance Use Surveillance System, the provincial government has changed how it reports opioid deaths.
The publicly available website will now update new data monthly, rather than every three months. It has grown to include information on people who died from alcohol poisoning and other substance misuse.
Users can look at data from nine publicly run opioid treatment clinics and look up ambulance calls, emergency room visits, hospitalizations and deaths by urban centre.
Luan said he hopes it will allow the government and the public to quickly see whether their policy decisions are effective, or whether they need to change course.
He said it's the most detailed and comprehensive public data set in the country, and challenged other provinces to match it.
With files from Erin Collins