Alberta's virtual opioid program's reach expands as treatment behind bars accelerates

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As the Alberta government wraps up a months-long $933,000 public ad campaign promoting its virtual opioid treatment program in mid-March, the team that provides remote prescriptions for those looking to get off opioids has already expanded its reach.

First launched in 2017 in central Alberta, the Virtual Opioid Dependency Program (VODP) now offers publicly-funded medication and treatment remotely, province wide, and the number of patients accessing it has skyrocketed.

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A total of 7,036 Albertans accessed treatment through the program in 2022-’23 — a count more than five times higher than the 1,225 clients the program saw in 2019-20.

In the 2020-’21 fiscal year, the program had 2,123 total clients and, in the next year, that climbed to 3,491.

Most clients access it through the phone, getting same-day treatment, including prescriptions to Suboxone and Sublocade. Those drugs can provide stabilization, reduce cravings, and potentially block overdoses for opioid users.

According to the latest publicly-available data from the province, Suboxone was doled out to 7,984 Albertans in the third quarter of 2023. The most over that period, 3,040, were in the Edmonton zone. Sublocade, the injectable version, was dispensed to 1,609 people across the province. Those numbers show steady year-over-year growth, with Suboxone being dispensed to only 1,205 individuals province-wide in the third quarter of 2016.

While the Alberta Health Services (AHS) program has been offering same-day treatment to those arrested and detained in municipal jails since 2021, with medication being delivered directly to the cell block after medical consultation, it also started offering its services in July 2022 at the Edmonton Remand Centre.

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The largest correctional facility in Canada, with room for nearly 2,000 prisoners, it holds primarily inmates awaiting trial.

In just one year, from July 2022 to June 2023, 1,823 clients at Edmonton Remand received the program’s services.

Dr. Nathaniel Day, medical director of the program, told Postmedia in an interview most who reach out to the program are at home or in communities, but the number of people in police custody or the correctional system accessing the program has seen “significant growth,” estimating that numbers have recently more than doubled year-over-year.

Over a one-year period from April 2022 to March 2023, there were 1,594 referrals to the program through RCMP or police services, according to AHS.

Edmonton Remand consultations being fast-tracked

A pilot program specific to Edmonton Remand has been aiming to address a long waitlist of people waiting to get opioid agonist therapy while in corrections. Day noted that some were being released without getting treatment after developing a reduced tolerance, which can increase the risk of an overdose death.

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Day confirmed to Postmedia that in Edmonton Remand, VODP consultations can involve what he called “asynchronous telehealth” — when a video is recorded of a patient answering questions for VODP physicians to review remotely. It’s part of an effort to get people rapidly assessed and treated.

“The wait time now, from the time a person’s identified when they come through the doors to the time that we’ve got treatment orders for them to start treatment, is less than one day,” said Day.

In response to possible concerns about the use of recorded videos to diagnose patients seeking drug treatment, Day said potential legal and ethical issues were considered ahead of time, but nurses screen intakes, and patients can then ask for a live clinical visit or reject the program’s recommendations entirely.

There are patients in corrections who have a history of alcohol, cocaine or methamphetamine use who ask for opioid treatments, Day said, but he added staff can screen for specific withdrawal symptoms, order drug screens, and look at medical histories to see if patients have ever presented to health care providers with an opioid addiction.

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Medications like Naltrexone, which is often used to help treat alcohol use disorder, are “occasionally” prescribed through VODP, he said.

VODP staff can confirm and access personal medical histories through the provincial database of patient information, Connect Care.

Nathaniel Day
Dr. Nathaniel Day, medical director of the Virtual Opioid Dependency Program, takes part in a news conference on Dec. 20, 2021, where it was announced that Edmonton fire stations will serve as a hub in accessing opioid addiction supports in partnership with the Alberta government. Photo by David Bloom /Postmedia

VODP surveys indicate most patients are happy with the service, but Day confirmed the program’s clients are not connected to the province’s My Recovery Plan app. That health-care software system aims to track the progress of clients who are on the waitlist or have checked into the province’s publicly-funded addiction treatment facilities, but has yet to yield any publicly-available data.

However, Day said the goal of VODP is to get patients connected to a local face-to-face health provider, even if it takes a couple of weeks of stabilization, and the team provides ongoing treatment for as long as people need it.

“I’ve actually literally done a follow-up visit with someone who was sitting inside of a bulldozer at the bottom of a construction site, who is doing great and checking in and telling me how they’re feeling and how the medication is working for them and they didn’t have to take a day off work,” he said.

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Provincial government budget documents and annual reports do not explicitly detail the costs, staffing or prescription billing that might be associated with the VODP, although annual mental health and addiction spending has been expanding since the UCP took office and began focusing its attention on building what it calls a recovery-oriented system of care.

In a 2021 announcement, the government announced that total provincial funding for the VODP was $6.4 million annually.

In November 2022, it announced another $4.5 million over three years to expand the program for youth and young adults.

As of Monday, AHS had not provided specific details about the current funding envelope of the VODP to Postmedia.

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