Over the summer, there was a spike in opioid overdose numbers due to COVID-19 affecting the drug supply and harm reduction resources.
As winter approaches, those numbers may get worse, resulting in calls for Alberta to take a different approach to solving the province’s opioid problem.
However, the government is rejecting some of those solutions, including a safer supply program and continued funding to safe consumption sites.
Those rejections took place against the backdrop of the 301 accidental opioid deaths that happened in Alberta between April to June – a 97 per cent increase over the 153 deaths over the same period last year.
Over the later period, the COVID-19 pandemic made Alberta’s precarious supply of illegal narcotics even more unpredictable. Border closures have affected the flow of those narcotics, resulting in shortages and an increase in the fillers being used to cut the drug supply.
As a result, Kathleen Larose – the provincial programming coordinator for Alberta Addicts Who Advocate and Educate Responsibly – says “people have been purchasing more and using more to achieve the same effects.”
Larose, whose organization works directly with drug users through harm reduction and street advocacy, says people have also been experiencing unusual overdose symptoms that are more difficult to spot.
“(People have) appeared blue in the face because they are not getting enough oxygen to the brain and are currently overdosing but they are still alert,” Larose explains.
She has also seen a spike of carfentanil, an opioid more potent than fentanyl, in Alberta street drugs.
Tainted street drugs are not an issue isolated to Alberta. Caitlyn Marco, an outreach worker for the Umbrella Society in Victoria, B.C., has also seen a rise in deadly fillers.
“The newer trend that has been showing up is high doses of benzodiazepines,” says Marco.
Unlike opioids, benzodiazepines don’t respond to naloxone.
COVID has strained the system
As drugs become more toxic, harm reduction services have also faced COVID-19 constraints on their ability to help people. That includes safe consumption sites being forced to operate at a lower capacity due to pandemic health protocols.
During this time, Larose noticed a larger number of people using opioids outdoors and more needle debris around Calgary.
“When COVID-19 started, a lot of services shut down until they could figure out how to keep everyone safe,” Larose says. “A lot of people were displaced.”
As a result, Larose’s group dispatched outreach teams to help drug users.
“Our numbers of interactions increased about 40 per cent in those first couple months, which is huge,” Larose says. “There were a lot of people outside, figuring out what to do. And then there were people who were afraid to access services because they were scared to catch COVID.”
Marco says that has had deadly consequences.
“I would say roughly 15 of my clients have overdosed and died because of using alone in their homes and not being able to access things like safe consumption sites or one-on-one support.”
Both Marco and Larose are increasingly worried about what could happen in the winter. As temperatures plunge and the holidays approach, overdose numbers often rise.
“There’s naturally a lot of loneliness and depression that comes along with the holidays when they (drug users) don’t have family or are sleeping outside,” says Larose. “People will often use more or use different substances to forget that they are sleeping outside.”
This is an issue even in warmer climates, such as Victoria.
“The holidays are a hard time of year for a lot of people, but especially for people that I work with who have substance use and concurrent mental health challenges,” Marco explains.
“There’s this societal pressure to spend time with family, and a lot of people who have substance use challenges do not feel safe around family or are not welcome to be around family.”
Funding cuts make it harder to help
With holidays and colder weather rapidly approaching, Alberta government funding cuts to harm reduction services have alarmed harm reduction advocates.
Most recently, the Lethbridge safe consumption site has been forced to shut down. After the closure of that site, which was run by the AIDS Outreach Community Harm Reduction Education Support Society, Larose said she saw a huge spike in overdoses. Her colleagues once saw three overdoses during a single three and a half hour shift.
Currently, Alberta Health Services is operating a mobile consumption site in Lethbridge to replace the one they shut down.
“In the winter months, unless we figure out a solution other than the little consumption site that they’re using right now, we are going to see a huge spike in the winter (in Lethbridge). I think it’s going to be a bit catastrophic,” says Larose.
But the Alberta government stands by their decision to close that site.
In an email, Kassandra Kitz, the associate minister of mental health and addiction’s press secretary, says, “The AHS-operated mobile overdose prevention site has been successful thus far, with adequate capacity to serve the community.”
She says emergency medical services have responded to 36 per cent less opioid-related emergencies since the implementation of the mobile safe consumption site.
In the same statement, Kitz states, “We do recognize that the pandemic is not over which is why we are continuing to monitor opioid fatalities in the province closely and making investments where they are needed most.”
Safe supply could be a saving grace
One form of harm reduction that Larose has been advocating for nearly seven years, is a safer supply program. A safer supply program offers users regulated versions of illegal drugs that are often cut with toxic substances.
“Essentially, with the fentanyl crisis, it will keep people safer and it can be monitored and people can do it with supervision and what not,” Larose says.
She also believes a safer supply could play a factor in avoiding overdose deaths over the winter by taking some strain off other harm reduction services.
Alison McIntosh, a former harm reduction researcher for the Parkland Institute, also supports a safer supply program. She says it could benefit communities overall by reducing drug-related crime.
“By having a safe supply that is regulated, produced and distributed through official channels, you have the potential to reduce harm across a whole lot of issues that we face right now,” McIntosh says.
“It’s absolutely essential that our provincial government, who is in charge of public health policy and allocation of health funding, recognizes they need to check their ideology at the door.”
When asked about the possibility of a safe supply program, Kitz did not answer the question. She instead linked an article with previous statements made by the Associate Minister of Mental Health and Addiction, Jason Luan.
Advocates remain hopeful for change
For now, Larose and McIntosh emphasize the importance of keeping safe injection sites open. Safe injection sites not only protect users but also give them a sense of hope and community.
“They’re also a point of contact, a place where people can go for a familiar face or a cup of coffee. Those interactions are really important, especially for people who are considering treatment options,” McIntosh says.
In addition, Larose says, “When people access those services they can be led to other services that will further support them towards their recovery journey, wherever they’re at.”
“Recovery services are essential, harm reduction services are essential. Everyone is on their own continuum, wherever their journey is. We can’t just stomp people who are at the bottom of the totem pole further into the ground.”
Correction: An earlier version of this story misstated the length of Larose’s advocacy for harm reduction.