The Alberta government is expanding access to strong prescription opioids to treat substance use disorders while limiting where patients can seek treatment.
Mike Ellis, Associate Minister of Mental Health and Addictions, announced changes to the province’s Mental Health Services Protection Regulations on Wednesday that will prevent pharmacists and other dispensers from prescribing hydromorphone, heroin and fentanyl as an addiction treatment. Now only Alberta Health Services will be allowed.
The service is only available to people with severe opioid use disorder, who have not been able to start or stabilize on opioid agonist therapy (OAT) medications, such as suboxone. Patients will now have to use high-potency opioids under medical supervision at an AHS-licensed clinic, eliminating take-out doses.
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Service providers must have a treatment plan in place before a patient can access narcotics and must attempt to transition patients to lower-risk OAT medications.
At a press conference, Mr. Ellis said ensuring supervision of customers will prevent prescribed opioids from being traded or sold on the illicit market and will increase public safety. “When it comes to these drugs, the risk to patients and to our communities is just too high,” he said.
AHS has already taken control of prescribing the three opioids in Calgary and Edmonton and the government has said services will be available across the province within five months, by which time current prescribers will need to switch patients to drugs OAT or at an AHS clinic.
About 350 Albertans are currently being prescribed strong opioids, mostly at an AHS opioid addiction clinic.
Speakers at the press conference said the benefit of AHS being a centralized healthcare system is that it reduces inequities in healthcare, especially in rural areas.
“We were sick of seeing people die of an opioid overdose when they never had access to drug options that could reduce their risk of overdose death by more than 50%. So we’ve worked tirelessly over the past few years to bring care to people where they are,” said Nathaniel Day, medical director of AHS’ Virtual Opioid Dependency Program.
“The days are over where someone living in Drayton Valley has to hop in their car in the dead of winter and brave icy roads to get their dose at a pharmacy in Edmonton.
More than 7,400 Albertans have died from unintentional overdoses since 2016, the majority linked to opioids like fentanyl. While overdose deaths have fallen from a peak late last year, fatalities remain well above pre-pandemic levels.
In March 2020, the province announced it would stop funding its Injectable Opioid Agonist Treatment, or iOAT, program which offered hydromorphone by injection up to three times a day to patients who had failed oral treatments, such as those offered by the OAT.
After a lawsuit was filed against the government, arguing the closures would violate protected rights, the province agreed to continue funding the program for existing customers. However, no new clients were accepted.
Addictions physician Monty Ghosh said in an interview that while it’s not exactly iOAT, the province’s focus encompasses many aspects of the program that have made iOAT successful, such as a range of support services, access to injectable forms of opioids and the possibility for some people to have a “last chance” for a cure.
He said this will open up access to drugs like never before in Alberta and is confident safeguards are in place to ensure people who do not wish to undergo OAT will still be able to access higher-risk prescriptions. But he said barring community groups from prescribing and providing medical oversight could be a barrier to access.
“It’s not safe supply. It doesn’t follow the principles of safe supply, which is a harm reduction strategy, but it opens up a lot of options for customers who don’t do well with traditional treatments,” said said Dr. Ghosh.
Euan Thomson, co-founder of Each and Every, a business group that advocates for harm reduction in Alberta, said the provincial announcement is a step forward for access to a regulated drug supply, but “two steps back” because it requires too much medical supervision.
He expressed concern about the proximity and convenience of accessing prescriptions at AHS clinics, especially for people who use multiple times a day or who have had negative experiences with the medical system due to their drug use.
“It’s just one more set of handcuffs for people who use drugs,” Mr Thomson said.
“The focus on drug treatment is unfair and lacks evidence, when we know now that it is the toxicity of the drug supply that leads to death. People who plan to continue using drugs will have no choice but to remain exposed to what is available on the unregulated market.
The announcement also came just a day before the United Conservative Party announced a new leader, which could halt progress on that plan. But Mr Ellis said he had spoken with most of the leadership candidates and they were “absolutely supportive” of the current mental health and addictions strategy.