Q and A: University of Alberta expert speaks out on Edmonton's spiking opioid deaths

‘The toxicity of the drug supply remains the main challenge.’

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Alberta reached a record high for opioid related deaths in 2023 and some experts say there needs to be a movement towards integrating more solutions.

From January to December 2023, Alberta recorded 2,051 substance-related deaths. Opioid deaths accounted for the majority of drug deaths, at 1,867, a 13.9 per cent increase compared to 2021’s 1,639 deaths. Edmonton had the highest number of opioid-related deaths across all municipalities, with 673. Calgary was close behind with 629.

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Elaine Hyshka, an associate and the Canada Research Chair in health system innovation at the University of Alberta School of Public Health, sat down with Postmedia to talk about the issue. The Q and A has been edited for length and clarity.

What is driving the increase in opioid deaths?

The toxicity of the drug supply remains the main challenge. The illegal drug supply is very volatile and unpredictable and most people, when they purchase substances, can’t be sure what they’re taking and how strong it is or if it’s contaminated with other substances.

That makes it really difficult to avoid drug poisoning.

If you look at the available data in Canada, there has not been an increase in addiction. There has only been an increase in death and that’s because the toxic drug supply has changed. Until we recognize that reality and develop new strategies to mitigate the harm caused by the toxic drug supply, we’re not going to get out of the situation.

I think also a lot of the increase in drug poisoning deaths we’re seeing is driven by the fact that many people are pushed into precarious housing and poverty and are struggling.

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How does Alberta compare to B.C.?

The statistics are a little difficult to compare directly because B.C. reports only their total number of drug deaths.

Whereas Alberta typically focuses on opioid-related deaths, B.C is always going to be a bit higher because their numbers don’t disaggregate from substances to the same degree. But Alberta has an extremely high rate of drug poisoning deaths. It’s the second highest in the country and it is increasing.

How do you move away from reactive help?

There certainly have been investments over the last five or six years to expand access to open more recovery communities. But I think if you’re asking whether there’s been a concerted effort to address this crisis in a way that meets the scale of the problem, I would say no.

Things are getting worse but the investments are not changing. The strategies are not changing and the rhetoric is not changing.

I don’t think there is a reactive approach even because it seems like, if anything, we’re putting our heads in the sand and trying to pretend this isn’t an issue or it isn’t as bad of an issue as it is.

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This is an unprecedented time. We’ve never lived through something like this. We need to be putting our heads together and finding novel solutions because just doing the same things we’ve been doing for decades, even if we just increase them, is not going to be enough to get out of the situation.

When people relapse, their tolerance has gone down and the risk of death goes up.

In addition, we also need to recognize that there is a substantial portion of people in Alberta and across the country who do not meet criteria for addiction but are still using drugs and are still at risk of dying. We also need to identify strategies that will help support them to stay safer.

Until we recognize that reality and develop new strategies to mitigate the harm caused by the toxic drug supply, we’re not going to get out of the situation.

What solutions will help more?

I think there’s lots of potential to bring down the death rate by trying new things.

The first thing I think we need to do in Alberta is expand access to supervised inhalation.

We know that with the onset of these novel synthetic opioids that are really highly toxic and dangerous, a lot of people have transitioned to smoking drugs and they’re doing that because they think that that will help reduce the risk of drug poisoning.

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But we know that most people who die of an overdose in Alberta are dying following smoking and yet none of the supervised consumption sites allow people to smoke drugs there. That is a relatively quick and easy adjustment that could be made tomorrow. We could be accommodating inhalation at different sites across the province. I think that that would go a long way to bring down the increasing number of people we’re seeing who are dying in public.

In the longer term, I think we need to be expanding access to opiates treatment further.

Alberta has done a lot and it should get credit for the virtual dependency program. It’s enabled people to have access to next day treatment or sometimes same day treatment, which is really good, but we’re not reaching enough people in Alberta and we have to be asking why.

We need to increase access to those treatment medications further and do some research to understand who is not accessing these medications and how we can better connect them to treatment.

More efforts to support people that do end up in hospital, or end up in incarceration, to access housing and treatment and support following discharge would be really valuable.

I think we need to be also expanding the use of other medications beyond buprenorphine and methadone, which are really the backbone of Alberta’s response.

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