https://www.thestar.com/news/canada/2022/10/07/jason-kenney-is-going-but-the-controversy-over-his-opioid-policies-will-linger.html

EDMONTON—It was a signature Jason Kenney moment — standing on top of a building in Edmonton’s Ice District, the outgoing premier announced $124 million to help get more people into addiction treatment.

The announcement, one of his last as leader, was mostly uplifting.

But it didn’t take long for combative Kenney to emerge.

A reporter questioned how he would respond to criticism of Alberta’s “recovery-oriented system of care,” which some have likened to an abstinence-based model. The reporter noted that approach has been criticized because experts say it will only help a small percentage of people in active addiction.

Kenney bristled. The longtime politician is known for his political acumen and meticulous attention to policy, but also his willingness to spar.

“Throwing around this word, “abstinence,” like it’s some kind of a pejorative, what do you really mean? Not using lethal drugs?” he responded incredulously.

“I believe that the alternative approach, which we see creating a catastrophic outcome in B.C., of destigmatizing dangerous drug use, and in fact facilitating it, in fact legalizing it, I think that is consigning people trapped in addiction to basically slow-motion palliative care.”

It was a position and the type of language that has been consistent throughout Kenney’s tenure. He has repeatedly said he doesn’t support helping people inject “poison” into their bodies and compared supervised consumption sites to enabling people to die by “slow-motion suicide.”

Drug policy experts and advocates say Kenney has left his mark in how Alberta has responded to the opioid crisis — presiding over a province that has seen overdose deaths surge every year since the UCP took office, a trend consistent with other jurisdictions.

Under Kenney, the government has closed two supervised consumption sites, put another on hold and cancelled a planned mobile site. It introduced legislation requiring users to show ID to access them. It tried to end a pilot program providing high-potency opioid medications to people resistant to traditional treatments and opposed any attempts of federal funding trickling into Alberta to provide safe supply of medical opioids.

All of this was undertaken while Alberta consistently recorded Canada’s second-highest number of drug poisoning deaths per capita, after B.C. In 2021, 1,823 people in Alberta of drug poisoning, the highest number on record. The vast majority of those were due to contaminated opioids.

Alberta’s strategy has been focused on recovery spaces, committing to 8,000 spaces annually for people seeking treatment, as well as five recovery “communities” spread around the province: long-term treatment facilities that also aim to help people make lifestyle changes and build life skills. None have yet to open; the first is slated to open in Red Deer in November.

While some attribute the government’s recovery-focused approach to Kenney’s personal ethos and religious beliefs, others argue that it’s more about appealing to the United Conservative Party’s base, which tends to be conservative, rural and religious.

Garth Mullins, a longtime drug activist and user who played a prominent role in advocating for drug decriminalization in B.C., believes Alberta’s approach to addiction treatment isn’t informed by any individual or party, but is baked into the province’s identity.

“In Alberta, it’s like this rhetorical war. It’s the land of free-market capitalism, the land of pull yourself up by the bootstraps, the Protestant work ethic — these are the foundational cowboy-hat myths of Alberta,” Mullins said. “And they just collide with harm reduction.”

Government officials have repeatedly said the ultimate goal is to get people off drugs and into long-term recovery. This week, the government announced it would begin offering high-potency opioids such as hydromorphone, diacetylmorphine (prescription heroin) and fentanyl in Alberta Health Services-licensed clinics.

While the announcement took many by surprise, critics say it doesn’t nullify government actions over the last three years and introduces new issues.

The government’s approach overemphasizes the danger of addiction and ignores the real reason people are dying — the toxic street drug supply, said Donald MacPherson, founding executive director of the Canadian Drug Policy Coalition and an adjunct professor at Simon Fraser University.

“What Jason Kenney is really saying is that he doesn’t approve of places where people will be saved if they inject poison into their bodies and overdose,” MacPherson said. “No one wants people injecting poison into their bodies. But they are, in big- and small-town Alberta every day and every night. So the whole point is to provide better safety for those people.”

He characterized long-term treatment facilities as a high-threshold service and estimates that it will only help roughly 10 to 15 per cent of people in active addiction.

“There’s not that many people that can make it through the door … that’s why the very low-threshold services, like supervised consumption sites, meet the needs of a population of people who aren’t going to make it into an abstinence-based context today or tomorrow.” ‘

U.S. government data shows that only about 10 per cent of people in active addiction enter treatment and less than half of people complete it.

One of the Kenney government’s legacies will be moving away from services aimed at vulnerable people, such as supervised consumption sites, and introducing supports for more affluent citizens, such as an app that alerts emergency services if someone is overdosing when using alone, said Rebecca Haines-Saah, an associate professor of community health sciences at the University of Calgary.

In Saturday’s announcement, Kenney noted that 70 per cent of overdoses occur in people’s homes “among people who are very unlikely to drive downtown and go to a drug injection site.”

“It’s mobilized in a way to counter the need for supervised consumption sites,” Haines-Saah said. “And it’s super-convenient to paint people at risk as people who are quote unquote using in secret. So it again sets up this binary between unstable, criminal, addicted persons and the productive person who’s hiding in the suburbs.”

Another announcement that raised eyebrows this week was the government saying they would fund “hybrid health and police hubs,” where police would ostensibly connect people to treatment services.

The government said this week its new regulations would expand access to medication for people with severe opioid addiction and “protect the public” from high-risk opioids. But MacPherson said it does the opposite.

The legislation will expand access to high-potency opioids to four cities in addition to Edmonton and Calgary. But patients will now only be able to access their medication at Alberta Health Services clinics, eliminating the ability for pharmacists and primary care providers to prescribe them.

Patients will no longer be able to take medication home.

Dr. Nathaniel Day, medical lead of Alberta’s Virtual Opioid Dependency Program and a member of the province’s Opioid Emergency Response Commission, said one reason the government is introducing tighter regulations around high-potency opioids is because evidence shows that when they’re widely available, they are traded or sold illegally.

“There’s real concern that one intervention to help our most severely impacted ends up undermining (the system) intended to help people not get addicted in the first place,” he said.

“We’re going to allow more access to this high-intensity care to ensure the people who need it get it, and we’re also putting some safeguards around it to try and make sure that this opioid epidemic doesn’t spread into the next generation,” he added. “I think it’s pretty valid.”

But some of Day’s colleagues argue the ultimate effect of the new regulations is restricting access to high-potency opioids to “very specific settings and very specific circumstances” dictated by the government, said Elaine Hyshka, an associate professor in the University of Alberta’s School of Public Health.

For example, people in rural areas won’t be able to access them at their local pharmacy.

“When you impose that kind of rigidity on people, it’s really counterproductive in terms of recovery … Most people who want to maintain full-time employment and continue their family responsibilities and other aspects that give their lives meaning aren’t able to attend a clinic three times a day every single day just to get their medication,” she said.

One such person is Ophelia Cara. Because she received her medication under a pilot program that the Alberta government almost discontinued before a legal challenge, she’s often worried about losing access to the medication that she says keeps her alive.

Now she says she’s terrified.

Her fears arise from the new regulations around high-potency opioids, including hydromorphone (Dilaudid), which she credits for recovery from a severe fentanyl addiction.

The aspiring biology and chemistry student with a passion for animals, fashion and Shakespeare, said her medication has allowed her to take back her life.

“I haven’t tried to kill myself ever since I got the prescription. I haven’t done fentanyl since I got the prescription … The more that the province seems to come down on harm reduction, the more I fear for the stability and the happiness that I found,” Cara said. “Because my Dilaudid has been the only way I’ve managed to do that.”

She said she requires a shot every day at 3 a.m. and it takes about two hours to get to her nearest clinic.

“Taking away the take home options really, really affects me as a person. It affects my ability to get back into school, it affects my ability to spend time with my mom in the evenings, it affects everything.”

She said a one-size-fits all solution won’t work for her and worries she’ll relapse on street fentanyl if she can’t access her medication three times a day.

Hyshka questions the government’s overall approach which she contends will ultimately limit access to pharmaceutical high-potency opioids, used by a small percentage of Albertans, while doing nothing about the toxic drug supply that is killing people.

“The vast majority of overdoses are linked to illegal street drugs. And so restricting access to these pharmaceutical grade alternatives that people are potentially being stabilized on is really solving a problem we don’t have,” she said.

Provincial data shows 96 per cent of opioid deaths in Alberta are caused by non-pharmaceutical opioids. MacPherson said research shows that when opioid prescribing decreases, overdose deaths went up.

Euan Thomson, executive director of Each And Every, a coalition of businesses supporting harm reduction, points to data from the chief medical officer of Alberta that backs this up.

The reason is because if people can’t access prescription opioids through legal channels, they’ll simply go back to the street to more potent, unpredictable drugs such as illicit fentanyl.

He says the government’s current approach of opening treatment spaces won’t actually make a dent in the number of people dying of drug poisoning.

“It’s not so much about what the Kenney government did than it is about what it didn’t do … There’s a big cohort of people that say our main metric (for success) should be ‘Are we reducing drug poisoning deaths?’ and the other group of people are saying we need to get people off drugs and abstinence is the goal,” Thomson said.

“That misalignment ends up basically sacrificing thousands of people to this idea that if you can’t get to abstinence, then you don’t deserve to live.”

Omar Mosleh is an Edmonton-based reporter for the Star. Follow him on Twitter: @OmarMosleh