Hundreds of Albertans Call on Jason Kenny to Save Canceled Treatment Program

Call to Maintain Funding for Alberta’s Injectable Opioid Agonist Treatment Clinics

The injection room of the iOAT program in Edmonton. This highly effective program is slated to close in March 2020.

An open letter to the Government of Alberta Honourable Jason Kenney, Premier

Cc: Honourable Tyler Shandro, Minister of Health, Alberta Honourable Jason Luan, Associate Minister for Mental Health and Addictions David Shepherd, MLA, Opposition Critic for Health Heather Sweet, MLA, Opposition Critic for Mental Health and Addictions Dr. Deena Hinshaw, Chief Medical Officer of Health Honourable Patty Hajdu, Minister of Health, Canada

Dear Premier Kenney,

We, the undersigned are a group of Albertan patients, families, physicians, nurses, pharmacists, social workers, counsellors, peer workers, academics, and concerned citizens of the province. We are writing to express our grave concerns with your government’s decision to discontinue funding for Edmonton and Calgary’s injectable opioid agonist treatment (iOAT) programs after March 2021. Many of us have experience providing iOAT. Some of us and our families have directly benefited from receiving this life-saving treatment. All of us understand the need for iOAT as part of the full spectrum of care for people as they recover from the impacts of opioid use disorders and have been encouraged by the remarkable health and social benefits of this treatment to the people who receive it, to their families, and to the community at large.

While much of the health care system’s attention has turned towards protecting Albertans through the global COVID-19 pandemic, we also recognize that people at risk of severe adverse outcomes from substance use disorders are at the intersection of both the pandemic and the opioid overdose crisis which continues to exact its toll on communities across Canada. Alberta remains one of the hardest hit provinces with close to two people dying daily as a result of accidental opioid poisoning (1) and reports of increasing EMS calls for overdose (2) and the re-emergence of carfentanil in the drug supply3 make us concerned that this crisis has worsened over recent months. At this time more than any before, we must offer all evidence-based treatments to patients. The decision to discontinue funding to iOAT makes this option inaccessible for Albertans who may seek help as the programs are no longer able to accept new patients. Those who are currently benefiting from this treatment will be forced off of it in the coming months and many of these individuals may suffer severe adverse outcomes as a result.

In September 2019, the Canadian Research Initiative in Substance Misuse (CRISM) published National Guidelines on iOAT for Opioid Use Disorder. National experts thoroughly reviewed scientific evidence to develop these guidelines which were subject to expert peer review. The guidelines are clear: iOAT is a necessary treatment option for individuals with severe injection opioid use disorders that have not responded to other treatments (4). Benefits demonstrated through scientific study include reduced illicit opioid use, improved retention in treatment and health care, reduced criminal involvement and incarceration, reduced mortality, and improved overall health and social functioning (5-8). Furthermore, studies in both Europe and Canada have consistently proven that iOAT is cost effective given the significant reductions in criminal activity (9-11) and hospitalizations (12) with their associated costs.

The National Guideline on iOAT for Opioid Use Disorder is also clear that iOAT should not be discontinued while a patient continues to benefit from treatment. Decisions to transition to other treatment options should only be made in collaboration with the patient and based on thorough risk-benefit assessments. Discontinuing funding for the programs removes that opportunity and forces their health care providers to practice against national expert guidance. Patients who have developed trusting relationships with these programs will be disengaged once again and many may not avail themselves of other treatments that have failed them before. These prospects are tragic as patients will be at tremendous risk of destabilization and related harms, including overdose mortality.

The iOAT programs in Edmonton and Calgary are benchmarks of what an intensive, multidisciplinary, and comprehensive addiction treatment program can offer for individuals at critical periods in the trajectory of their recovery. Their patients have access to not only life-saving medication treatment from physicians and nurse practitioners but are also supported in their recovery by peer workers, mental health resources, social workers, nurses, pharmacists, and primary care. Albertans can be proud of what these clinics have accomplished and the positive impacts on their communities. With ongoing support and funding, they could no doubt continue to thrive, support recovery, and offer hope to highly vulnerable patients. Premier, please do not end this evidence-based, cost effective treatment in Alberta. We call on the Government of Alberta to reverse its decision to discontinue funding to the Edmonton and Calgary Injectable Opioid Agonist Treatment Clinics and to continue to support this critical treatment option for Albertans.

Sincerely,

References:

1. Health, Government of Alberta, June 2020, Alberta Opioid Response Surveillance Report: Q1 2020. https://www.alberta.ca/opioid-reports.aspx

2. https://www.cbc.ca/news/canada/edmonton/drug-users-warned-of-dangers-after-spike-in-opioid-related-ems-calls-in-edmonton-1.5600260

3. https://edmontonjournal.com/news/local-news/spike-in-carfentanil-deaths-opioid-overdoses-in-edmonton-prompts-health-warning

4. Canadian Research Initiative in Substance Misuse (CRISM). National Injectable Opioid Agonist Treatment for Opioid Use Disorder Clinical Guideline. Published September 23, 2019. https://crism.ca/projects/ioat-guideline/

5. Ferri M, Davoli M, Perucci CA. Heroin maintenance for chronic heroin-dependent individuals. Cochrane Database of Systematic Reviews. 2011(12). 10.1002/14651858.CD003410.pub4

6. Strang J, Groshkova T, Uchtenhagen A, et al. Heroin on trial: systematic review and meta-analysis of randomised trials of diamorphine-prescribing as treatment for refractory heroin addiction. The British Journal of Psychiatry. 2015;207(1):5-14. 10.1192/bjp.bp.114.149195

7. Oviedo-Joekes E, Guh D, Brissette S, et al. Hydromorphone compared with diacetylmorphine for long-term opioid dependence: A randomized clinical trial. JAMA Psychiatry. 2016;73(5):447-455. 10.1001/ jamapsychiatry.2016.0109

8. Oviedo-Joekes E, Brissette S, Marsh DC, et al. Diacetylmorphine versus Methadone for the Treatment of Opioid Addiction. New England Journal of Medicine. 2009;361(8):777-786. doi:10.1056/NEJMoa0810635

9. Nosyk B, Guh DP, Bansback NJ, et al. Cost-effectiveness of diacetylmorphine versus methadone for chronic opioid dependence refractory to treatment. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne. 2012;184(6):E317-328. 10.1503/cmaj.110669

10. Byford S, Barrett B, Metrebian N, et al. Cost-effectiveness of injectable opioid treatment v. oral methadone for chronic heroin addiction. The British journal of psychiatry : the journal of mental science. 2013;203(5):341-349. 10.1192/bjp.bp.112.111583

11. Byford S, Barrett B, Metrebian N, et al. Cost-effectiveness of injectable opioid treatment v. oral methadone for chronic heroin addiction. The British journal of psychiatry : the journal of mental science. 2013;203(5):341-349. 10.1192/bjp.bp.112.111583

12. Bansback N, Guh D, Oviedo-Joekes E, et al. Cost-effectiveness of hydromorphone for severe opioid use disorder: findings from the SALOME randomized clinical trial. Addiction. 2018;113(7):1264-1273. 10.1111/ add.14171

Supervised Consumption Sites under attack - "The impact will be death. There's no other way to put that," says Lori Hatfield, mom and MSTH advocate.

I belong to a peer group that provides me with love, support and understanding that I have not been able to find through other means, including professionals, family and friends. It is a group that no one wants to belong to and we wish you weren’t here. I belong to Moms Stop The Harm which is an advocacy group that wants to change failed drug policies by decriminalizing and providing safe supply. They also provide support to those families that have been impacted by substance use related harms and deaths.

As we close another summer and held events throughout the country and world for #IOAD2020 (International Overdose Awareness Day), it’s a time to reflect on where we are and how far we have come.

I’m very sad to say that in my home province of Alberta, we are moving backwards. Our current United Conservative Party (UCP) government only supports abstinence-based recovery. They are opposed to harm reduction and have stopped funding to our supervised consumption service (SCS) in Lethbridge. Under the name ARCHES, they operated 8 vital programs:

•         Supervised Consumption Services

•         Needle Debris Hotline (collecting discarded needles throughout the city)

•         Virtual Opioid Dependency (VOD) Program

•         Justice Services

•         Mic Club (listen to IOAD “Help Me”)

•         COAP (Community Outreach Addictions Program)

•         Take Home Naloxone

•         Urban Spirits Nursing Clinic

These services are no longer available to our most vulnerable population. Their reason for closing was due to an alleged misappropriation of funds. While nothing has been proven yet, the UCP government, under the leadership of Jason Kenney, could have implemented new management while still keeping the services available. But instead, our government chose to make his voter base happy and closed the site on August 31st - the same day recognized at Overdose Awareness Day. Coincidence, or irony? You be the judge. The fact that they closed a vital service that kept people alive, that saw 600-800 people a day access one of their 8 services, that never had one fatality and took the pressure off our EMS and emergency hospital services is mind-boggling to so many.

On the same day of the Lethbridge SCS closing, a breaking news story announced the approval, by Jason Luan (the Associate Minister of Mental Health and Addiction), of thousands of dollars in expenses for the SCS Review Panel that travelled Alberta last fall. Approval of prime rib dinners, alcohol and hotel rooms that were never used – this appears to be okay with our UCP government.

There has been much divisiveness in our community and other communities in Alberta regarding harm reduction. For me, harm reduction is not the issue. Rather the lack of services we have in our city and amongst other cities is where the real issue lies! In Lethbridge, ARCHES pretty much stood alone as services available to people living with addiction, they operated 24/7; 365 days a year. They were there for people when they needed someone. How many of our other services operate 8-5; Mon-Fri. I’m sorry, most crises happen on weekends or after hours; we have to have experts in the field be available to people when that window of opportunity opens and that’s not always going to happen between 8-5; Mon-Fr.

We, the people that have loved ones in addiction or that have died from overdose, have done the research – we live it night and day – it is with us 24/7. We know or are aware of the experts in the field that have done the schooling – more importantly, many of us have walked the path of and with someone living with addiction and have witnessed the barriers that are heaped one on top of the other for someone with this disease. Never in my life have a seen such chaos and senseless policies! Policies that make it nearly impossible for some with addiction to overcome. No other government programming operates like this.

Someone looking for help is expected to do many things depending on their choice of recovery. Here are just a few of the barriers. I have gone through each of these with my son while searching for help. These barriers are infuriating!

• Looking to go to treatment – first go to detox; there will be a wait to get in (but hang on to that thought of sobriety while you’re waiting days/weeks)

• You’ve been to detox – YEA!!! Hold on, there’s a waiting list for treatment; could take up to 30 days, maybe more (but make sure you call us EVERYDAY and let us know you’re still sober). Hmmmm don’t have a phone, well that could be a problem – how will you call us everyday; how will we call you and let you know a bed is available?

• Oh you’ve decided on Methadone or Suboxone – both good choices! Now, whaaat – I have to go to the pharmacy way across town (as not every pharmacy is allowed to dispense a narcotic) EVERYDAY, personally to get my prescription given to me! I have to wait, and hopefully the pharmacist isn’t judgmental and makes me wait even longer on purpose as I’m supposed to be at work right now. 

• I’m on Methadone, great now I have to do a pee test – oh I failed – you’re cancelling my methadone prescription – where does that leave me – back to finding toxic supply I guess. It was just a slip – I had a moment where I just slipped, please don’t cut me off my prescription! (how many other prescriptions are out there for some other kind of addiction but not monitored or treated with such discrimination as drug addiction).

These are just a few of the barriers that I have witnessed with my son. I’m a pretty strong-willed woman and I have intervened on some of the above issues for my son. I haven’t gotten very far either, but I will stand up and make a fuss if necessary, like at the pharmacy when they had us sit there for almost 30 minutes while there was NO ONE else at the pharmacy counter! How many of our vulnerable population will stand up to situations like this, or they may try but then will be asked to leave the store.

The discrimination and stigma faced by people who live with addiction and their families has got to change! It just has too. Trust us, we know “Addiction Doesn’t Discriminate”. There is a very good possibility it has already sunk it’s ugly teeth somewhere into your family – maybe you know about, maybe you don’t. Just know, even though we don’t want you to be a part of this group – we will always be here for you and will love and support you unconditionally through all your pain, heartbreak, successes and hurdles.

Lori Hatfield, Lethbridge, AB

Protesters stage 'die-in' outside Lethbridge City Hall against supervised consumption site closure

Southern Alberta Moms Stop The Harm Memorial Photo at Piikani Nation Remembers Lives Lost to Overdose Crisis

Piikani First Nation, July 12, 2020

In a powerful statement to remember loved ones lost from substance use-related causes, Moms Stop The Harm (MSTH) southern Alberta members in partnership with Piikani Nation gathered on Piikani traditional land for the sixth in a series of iconic memorial photos.  The intent is to continue to draw attention to the ongoing loss to opioid poisonings and other substance use-related causes so lives can be saved. During the COVID-19 pandemic, overdose rates have risen significantly across the country and families demand that this ongoing health emergency is given the same attention as coronavirus.

“The purpose of these photos is to remember our lost children and acknowledge that their lives matter,” says Petra Schultz, MSTH Co-Founder. “It’s also an important opportunity to raise awareness of changes that need to be made in the community so other families don’t suffer the same loss.”

This memorial photo marked a partnership between bereaved MSTH families from communities across Alberta and the Piikani Nation.  It was the first MSTH memorial photo to take place on a First Nations reserve. Indigenous people are disproportionately affected by the overdose crisis.  In Alberta, First Nations people are dying from opioid poisoning at a rate three to four times higher than non-First Nations people[i]. Piikani Nation is just one of many Indigenous communities hit hard by the dual health crises converging, with four opioid-related deaths occurring in just the last couple of weeks.

“One of the solutions we need to prevent opioid poisoning deaths is getting wider access to nasal spray naloxone.  While it is funded through pharmacy, there are still significant barriers for many Indigenous people,” says Brian Jackson, Band Councillor, Piikani Nation.  “It needs to become accessible from local Public Health Units as the more widely it’s available, the more people it can help.”

The event brought together Indigenous and non-Indigenous communities to tackle a crisis that affects all Canadians. It also educated members of Piikani Nation about the supports available to them and engaged the community in an important dialogue about the overdose crisis.

MSTH members from around southern Alberta who attended remembered their loved ones together with members of Piikani Nation who suffered the same losses. The pain of losing a child or a loved one is the same for these families and overdose deaths are preventable.

This is how Kym Porter, one of the MSTH members who came from from Medicine Hat, describes the event:

On Sunday, July 12, 2020 under an expansive sky promising to cooperate, a number of Southern Alberta family members gathered on the sacred land of the Piikani First Nation for the sixth in a series of iconic MSTH photo shoots.

The beauty of the Rocky Mountains in the background enveloped by the continuous fields of wildflowers was in sharp contrast to the torment and trauma experienced by the loved ones gathered to honour and pay tribute to the too many lives lost needlessly to the overdose crisis. Elder Jordan led us in prayer spoken profoundly in the Blackfoot language.

We then gathered in a field, cradling in our arms the pictures of our loved ones as the wind sent us each secret messages. As I stood in awe, with deep respect for the collective grief and the gifts of this natural location, I felt honoured to be invited here all the while sensing the immense, palpable connection. We gathered to speak of and to our loved ones. We gathered to help us heal. We gathered in strength and solidarity to support the passionate call for decriminalization, safe supports and a non judgemental approach for those who are struggling. We gathered in love.

About the Moms Stop The Harm Memorial Photo Series

The images are part of a series from across the country, with more to come. In February, Edmonton and northern Alberta families gathered at the bank of the North Saskatchewan River. In January members in Powell River BC stood at a local beach for their photo, in late November families from Vancouver and the Lower Mainland gathered for the second installment on Jericho Beach. The first photo was taken on Knox Mountain in Kelowna in September 2019 and a future photo is planned in Regina in August, using the crosses from this event.

About Moms Stop The Harm

Moms Stop the Harm (MSTH) is a network of Canadian families impacted by substance use-related harms and deaths. They advocate to change failed drug policies and provide peer support to grieving families and those with loved ones who use or have used substances.

Mome stop the Harm calls for an end to the criminalization of people who use drugs and safe pharmaceutical alternatives to toxic street drugs, ready access to harm reduction services and treatment on demand.

This photo was a team effort and we are thankful to:

• All families who attended, those who drove from other communities and those who are part of Piikani Nation. We are sorry for and most of us share your grief.

• The Elders who blessed the gathering and the land

• Our MSTH organizers for this event (Lori Vrebosh and Lori Hatfield. ) and our media spokespeople.

• Mountain Drift Photography for the donation of photo services

• The makers of the overdose reversal drug Narcan Nasal Spray for covering the costs incurred by Piikani Nation during the event.

MSTH families strongly object to proposed involuntary care of youths in BC

An open letter to Judy Darcy, British Columbia Minister for Mental Health and Addictions regarding Bill-22-2020 The Mental Health Amendement Act.

Moms Stop the Harm (MSTH), an organization of over 1,300 families in Canada who have all had close experiences with the crisis of overdose and drug-related death, does not support Bill 22, the proposed amendment to the BC Mental Health Act..

The amendment, Bill 22, the involuntary care of youth who present at a medical facility in an overdose state, is counterproductive.  This amendment on involuntary care was drafted with little or no collaboration from stakeholders - families and youth - and will likely have serious negative, unintended consequences for the young people it aims to help.

In the experience of our families, involuntary care does not lead to successful recovery. In fact, we see that it is likely to break a youth’s trust in both the health system and the family - a harmful and devastating outcome that has resulted in the death of a child for a number of families in our community.

Involuntary care will have a destabilizing effect on youth, which may increase their risk of overdose upon release. For many youth who need our help the most, this amendment may have the opposite of its intended outcome. For instance, many marginalized youth who have experienced the health and social systems, including social services, have already lost faith in the state, given that such involvement has often resulted in a negative experience.  Youth may perceive involuntary care as ‘incarceration’ which will exacerbate their lack of faith, thus leading to poor long-term outcomes. 

A further unintended consequence of this amendment is that youth witnessing a friend’s overdose may avoid calling 911 if they know that the possibility exists that they or a friend might be held for up to seven days against their will.  

There are too few health professionals in the province trained and skilled in addiction medicine, especially for youth.  Given that most youth in B.C. have little to no immediate care after overdose, particularly those who live in rural and remote communities, how will they benefit from involuntary care when the infrastructure is simply absent?  Removing them from their home communities, their families, is not the answer.

A further concern is the limited research done in this area; the scant research available does not support the Bill 22 model.

Where services for youth are urgently needed, but absent, is in harm reduction. This was identified by the Advocate for Children and Youth in a report released in November 2018:

The Representative firmly believes that B.C. should be building a comprehensive array of prevention, early intervention, care, treatment and post-treatment services for youth and that harm reduction must be a necessary part of this spectrum of services, especially for youth with significant and severe substance use issues (Advocate for Children and Youth, 2019, p. 1).

Of concern is that Bill 22 has little mention of the impact these changes will have on the family paradigm, nor does it outline the inclusion of families in the care of their loved ones. Families have an important role in supporting children and youth who experience challenges with substance use; families must be supported and involved in the care of their children whenever appropriate.

A further concern is the limited research done in this area, and the research that is available does not support this model.

Rather than implement involuntary approaches to substance use, the Province must instead focus on creating a provincial evidence-based, youth-focused system of care where one presently does not exist, as outlined in the above mentioned report by the Representative for Children and Youth

As the families of Moms Stop the Harm, we strongly object to Bill 22 in its current form, and urge the government to engage in meaningful dialogue with all stakeholders to develop services that actually will help, rather than harm our children.

Leslie McBain, Co-founder

For the British Columbia Members of Moms Stop the Harm, The Board of Directors of MSTH

Press Release: Moms Stop the Harm wants urgent action to end overdose crisis

VICTORIA, BC - Moms Stop the Harm (MSTH) spokesperson and co-founder Leslie McBain said, “We want to know how many more of our loved ones have to die before governments take the opioid crisis seriously,” in response to figures released today by the Public Health Agency of Canada on the number of opioid-related deaths in 2019.

The agency reported 3,823 deaths in 2019, bringing the total number of fatalities to 15,393 in the last four years alone.

McBain said that this year’s death toll is likely to be worse due to social isolation, an increasingly toxic drug supply and reduced harm reduction, treatment and recovery services. In some provinces and territories, the number of overdose deaths will likely be more than the number of people to die from COVID-19.

“That’s right, we have more than one national public health emergency on our hands and we think it’s time for the federal government to acknowledge this by declaring it as one so that it is taken seriously and funded appropriately,” said McBain.

“We call for urgent action to end the criminalization of people who use drugs because it causes them to use and die alone,” said McBain. “We also call for community-driven, lower barrier models for safer supply, which allow people to replace toxic street drugs with safer pharmaceutical alternatives.”

McBain noted that safer supply could be implemented right now in all provinces, based on new federal “pandemic prescribing” guidelines, but most provincial governments lack the political will to do so. “They choose to ignore the fact that dead people don’t recover,” she said.

 “We need urgent action so that our children, family and friends don’t die before they are able to get help,” said McBain. “Our loved ones don't have to die. Most opioid related deaths are preventable. We can fix this, but governments need to do more. A lot more.”

 “At the moment, there is no comprehensive pan-Canadian plan to address the opioid crisis. This is a shameful and heartbreaking state of affairs. As a society, we need to do better,” said McBain.

MSTH is a network of Canadian families impacted by substance use related harms and deaths. We advocate to change failed drug policies and provide peer support to grieving families and those with loved ones who use or have used substances.

For more information, contact Info@momsstoptheharm.com

Leslie McBain, Pender Island, BC - Deborah Hale Bailey, Vancouver, BC - Helen Jennens, Kelowna, BC - Petra Schulz, Edmonton, AB - Angela Welz, Edmonton, AB - Marie Agioritis, Saskatoon, Saskatchewan - Sheila Jennings, Toronto, ON - Christine Wingate, Ottawa, ON - Isabelle Fortier, Montreal, QC