Judge reserves decision on injunction seeking to maintain Alberta opioid treatment program
Critics say patients are in peril. Province contends that 'nothing will change'
Alberta clients of a treatment program considered to be a last resort for people with the most severe opioid addictions will have to wait for a decision on the fate of the program.
Edmonton Court of Queen's Bench Justice Grant Dunlop reserved his decision Wednesday on an emergency injunction that seeks to maintain provincial government funding for the opioid agonist treatment (iOAT) program.
Dunlop told the court he recognizes the urgency of the request but will likely not release a decision until the end of the month. Clinics in Edmonton and Calgary offering the treatment are set to close March 31 when their provincial funding runs out.
Opioid agonist treatment allows patients to inject a medical-grade opioid called hydromorphone three times daily under the supervision of a nurse. It is only offered when all other treatments had proven ineffective.
Clients enrolled in the program are also provided access to a variety of services including psychological, financial and housing supports.
'Nothing is going to change'
The province has said that all current patients will be referred to comparable treatment before the program officially ends.
The court was told Wednesday that clients will still be supplied with injectable hydromorphone through Alberta Health Services at 10 opioid dependency program (ODP) clinics across the province.
Lawyers representing the province asked that the application for an injunction be dismissed, arguing that access to treatment for users of the program would remain largely unchanged.
Lawyer Nate Gartke said some services, such as primary care, may not be available but referrals would be provided as needed.
"From a patient perspective, nothing is going to change," Gartke told the judge.
The injunction, filed by 11 Albertans struggling with severe substance abuse, would have prevented all iOAT patients from being denied the treatment until a lawsuit concludes.
The lawsuit filed last year against the provincial government argues that discontinuing the program would be dangerous.
The statement of claim, filed Sept. 30 in the Edmonton Court of Queen's Bench, alleges that cancelling the treatment infringes on patients' charter rights by putting their lives and personal security in peril, and amounts to discrimination. None of the allegations has been proven in court.
Edmonton lawyer Avnish Nanda, who is representing the plaintiffs pro bono, expects the lawsuit will take years to resolve but said the treatment programs need to be reinstated immediately.
"Without treatment, these users are at risk to violence, disease, and death. Premature death," Nanda told the judge Wednesday.
"We're really talking about the most vulnerable and marginalized group of opiate disorder patients in Alberta."
Critics warn of fatal consequences
Nanda said severe addictions drive users to rely on street drugs, a supply that has become increasingly toxic since the COVID-19 pandemic began.
Without iOAT, many will return to that contaminated supply to feed their habits, he said, and some already have.
Court was told that at least one client of the program died after disengaging with treatment, and one of the plaintiffs in the lawsuit has since contracted HIV.
Nanda said the program provides clients relief from the cyclical nature of their disease, allowing them to access essential services and rebuild their lives.
The ultimate goal of the program, he said, is not to get users off drugs to but allow them to get help and ultimately save lives.
"It's a harm reduction approach," he said. "It's taking these individuals as they are and trying to engage them in the health-care system."
"It's looking at the whole picture."
This new treatment isn't approved yet. We're really talking about a hypothetical here.- Avnish Nanda, lawyer
Nanda said the details of the injection treatment being offered by the province remain unclear, a lack of transparency he described as "fatal to the defence" levied by the government.
He noted that the province only decided to continue injection treatments in November. He said 80 clients still enrolled in iOAT remain anxious about the future.
"We have no details of this alternative treatment and we just have assurances that it will come, and that is not good enough," he said.
"This new treatment isn't approved yet. We're really talking about a hypothetical here. The funding isn't approved yet. They haven't even submitted a grant approval request."
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 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 province has said it expects that all patients will be transitioned out by the end of March.
A 'Cadillac service'
In his submission to the judge, Gartke characterized the therapy as novel and untested and said the program was always designed as a pilot.
He said if the program ends clients would still be provided good care.
"There was a program that provided, what we would suggest is a Cadillac service," he said.
"That program is not continuing but all of the ancillary services, all of the wraparound services at issue here are still available, some even on site at the ODP clinics.
"The applicants here are not being deprived of their life, liberty or security of the person because they still have access to the injectable hydromorphone. They still have access to all of the wraparound services that they require.
"We're not going to be providing them a car that doesn't have a transmission or windows. We're going to be providing them with a fully functioning service."