Addictions
New organizations for mental health and addictions to provide focused care and take pressure off health system
Refocusing health care: mental health and addiction
Alberta’s government is creating two new organizations that will support the development of the mental health and addiction system of care.
In November 2023, Alberta’s government announced it would be refocusing health care with the creation of four new organizations that will be responsible for the oversight and delivery of health care services in the province. The four new organizations include acute care, continuing care, primary care and mental health and addiction. The mental health and addiction organization will be the first of these to be established when it becomes an entity later this year.
The new mental health and addiction organization, Recovery Alberta, will be responsible for the delivery of mental health and addiction services currently delivered by Alberta Health Services (AHS). In addition, Alberta’s government is establishing the Canadian Centre of Recovery Excellence (CoRE) to support Alberta’s government in building recovery-oriented systems of care by researching best practices for recovery from around the world, analyzing data and making evidence-based recommendations.
“Refocusing health care enables us to better prioritize the health care and services Albertans need. Giving Albertans living with mental health or addiction challenges an opportunity to pursue recovery and live a contributing life is the responsible and compassionate thing to do. I am so proud of the work we have done to be leaders on recovery, and I am looking forward to seeing both Recovery Alberta and the Canadian Centre of Recovery Excellence continue this work for years to come.”
“Alberta is leading the country with the development of the Alberta Recovery Model to address mental health and addiction challenges. The establishment of these two new organizations will support the delivery of recovery-oriented services to Albertans and will further cement Alberta as a leader in the field. We are proud to establish Recovery Alberta and CoRE as part of the Alberta Recovery Model.”
“We’re making good progress on refocusing health care in Alberta. Today marks a pivotal milestone towards creating a system that truly serves the needs of Albertans. Through this refocused approach, our aim is to prioritize the needs of individuals and families to find a primary care provider, get urgent care without long waits, access the best continuing care options, and have robust support systems for addiction recovery and mental health treatment.”
Recovery Alberta
In August 2023, Alberta’s Ministry of Mental Health and Addiction began the process of consolidating the delivery of mental health and addiction services within AHS, a process that was completed in November 2023 with no disruption to services.
Recovery Alberta will report to the Ministry of Mental Health and Addiction and further support the Ministry’s mandate to provide high-quality, recovery-oriented mental health and addiction services to Albertans. It is anticipated Recovery Alberta will be fully operational by summer 2024 and will operate with an annual budget of $1.13 billion from Alberta’s government. This funding currently supports the delivery of mental health and addiction services through AHS.
The current provincial leadership team for Addiction and Mental Health and Correctional Health Services within AHS will form the leadership team of Recovery Alberta. When Recovery Alberta is fully established, Kerry Bales, the current Chief Program Officer for Addiction and Mental Health and Correctional Health Services within AHS will be appointed as CEO. Dr. Nick Mitchell, Provincial Medical Director, Addiction and Mental Health and Correctional Health Services within AHS, will become the Provincial Medical Director for Recovery Alberta.
“Recovery Alberta will build on the strong foundation of existing mental health and addiction services that staff and clinicians deliver. By working closely with Alberta Mental Health and Addiction and the Canadian Centre of Recovery Excellence, Recovery Alberta will continue to set a high standard of care for mental health and addiction recovery across the province, and beyond.”
“Albertans deserve patient-centered care when and where they need it. By establishing Recovery Alberta, we have an opportunity to work together in a new way to make that a reality for our patients and our communities.”
While timelines are dependent on legislative amendments yet to be introduced, the Ministry of Mental Health and Addiction is aiming to establish the corporate structure of Recovery Alberta by June 3. Following the establishment of the corporate structure and executive team, staff and services would begin operation under the banner of Recovery Alberta on July 1.
Frontline workers and service providers will continue to be essential to care for Albertans. To ensure stability of services to Albertans, there will be no changes to terms and conditions of employment for AHS addiction and mental health staff transitioning to Recovery Alberta. Additionally, there will be no changes to grants or contracts for service providers currently under agreement with AHS upon establishment of Recovery Alberta.
Canadian Centre of Recovery Excellence (CoRE)
Alberta’s government has been leading the country in creating a system focused on recovery by building on evidence-based best practices from around the world. In five years, Alberta has removed user fees for treatment, increased publicly funded treatment capacity by 55 per cent and built two recovery communities with nine more on the way. Alberta’s government has also pioneered new best practices such as making evidence-based treatment medication available same day with no cost and no waitlist across the province through the Virtual Opioid Dependency Program.
To continue the innovative work required to improve the mental health and addiction system, Alberta’s government is creating the Canadian Centre of Recovery Excellence to inform best practices in mental health and addiction, conduct research and program evaluation and support the development of evidence-based policies for mental health and addiction. CoRE will be established as a crown corporation through legislation to be introduced this spring.
Alberta’s government has committed $5 million through Budget 2024 to support the establishment of CoRE. It is anticipated CoRE will be operational by this summer.
The CoRE leadership team will consist of Kym Kaufmann, former Deputy Minister of Mental Health and Community Wellness in Manitoba as the CEO. She will be supported by Dr. Nathaniel Day as Chief Scientific Officer of CoRE. Dr. Day currently serves as the Medical Director of Addiction and Mental Health within AHS.
“There is a need for more scientific evidence on how best to help those impacted by addiction within our society. The Canadian Centre of Recovery Excellence will generate new and expanded evidence on the most effective means to support individuals to start and sustain recovery.”
“The Canadian Centre of Recovery Excellence will provide the research and data we need to understand what works best when it comes to recovery. This new expertise and expanded evidence will provide us with further insight into how we can support communities, service providers and frontline staff to effectively help those living with addiction and mental health challenges.”
Quick facts
- Budget 2024 will invest more than $1.55 billion to continue building the Alberta Recovery Model.
- This includes a $1.13 billion transfer from Health to Mental Health and Addiction (MHA) for mental health and addiction services currently delivered by Alberta Health Services.
- Virtual engagement sessions for AHS staff and service providers will be held on April 11, 16, 17 and 22.
Related information
Addictions
Man jailed for trafficking diverted safer supply drugs, sparking fresh debate over B.C. drug policies
Nanaimo drug trafficker’s case is further evidence of safer supply diversion. But some sources say even diverted drugs reduce harm
In early May, 68-year-old Ronald Schilling of Nanaimo, B.C., was sentenced to three years in prison for trafficking street drugs such as fentanyl and meth — as well as government-supplied opioids.
When authorities had arrested Schilling two years earlier, they had found him in possession of more than 80 government-supplied opioid pill bottles labeled with other patients’ names.
Those pills had been dispensed to patients under B.C.’s “prescribed alternatives” program, more commonly known as safer supply. The program aims to reduce overdose deaths by dispensing pharmaceutical opioids to drug users as an alternative to toxic street drugs.
In Schilling, patients of this program had found a drug dealer who was willing to give them harder drugs — such as fentanyl — in exchange for their prescription opioids. Schilling would in turn sell their prescription opioids to others.
“Mr. Schilling preyed upon people who were taking the safe supply drug,” Provincial Court Judge Karen Whonnock said during the sentencing hearing.
Schilling’s case is further evidence that safer supply opioids are making their way to the streets — and having unintended negative consequences. However, some sources say even diverted pills reduce harm if they flood the market with safer drugs.
‘Upside Down’
Schilling, a former charity worker, developed a cocaine addiction after the sudden death of his partner. He ultimately turned to drug trafficking to fund his addiction, according to his lawyer.
In court, the prosecution described Schilling as operating a mid-level drug trafficking scheme that exploited B.C.’s safer supply program.
Schilling coordinated with multiple dealers to source both illicit and prescription drugs, and had at least three individuals working under him. His text messages showed he would arrange to meet clients near Nanaimo’s Outreach Pharmacy to trade potent street drugs for the prescribed medications they had just received.
He operated under the name “Upside Down Inc.” — “down” being a street reference to fentanyl — and had business cards to match. To reassure users that the street drugs were safe, he would have them tested at a local overdose prevention site.
‘Predatory behaviour’
While Schilling’s case is unusual, it adds to the growing body of evidence that provincial safer supply programs are not always being used as intended.
In one example, a B.C. government report released in February revealed that more than 60 pharmacies were involved in a kick-back scheme, offering patients cash or rewards to fill safer supply prescriptions they did not need. Some of those drugs were then sold on the black market.
Collen Middleton, a co-founder of the Nanaimo Area Public Safety Association, refers to safer supply drugs as the “perfect consumer product.”
“They are a product that produces its own demand, because it’s addictive,” said Middleton, whose neighbourhood association is a vocal critic of safer supply.
One of Middleton’s concerns is that safer supply drugs are presented as safe, despite being addictive themselves. He says this makes them an effective gateway to more dangerous street drugs like fentanyl.
“Those drugs are being marketed as safe to kids … [so] you’re bringing more people into using addictive drugs, more abuse, more predatory behaviour toward a vulnerable segment of the population,” he said.
The B.C. Ministry of Health told Canadian Affairs in an emailed statement that it takes the “diversion of prescription medications … very seriously.”
“The unauthorized distribution is illegal and puts the public at risk,” it said.
In response to the B.C. pharmacy scandal, the province tightened its protocols for dispensing prescription opioids. All new and most existing patients must take prescription opioids under the supervision of health-care professionals, a protocol known as witnessed dosing. In rare cases, existing clients may continue to take their doses offsite if the prescriber views the risk of diversion as low.
Mixed evidence
In its statement to Canadian Affairs, B.C.’s health ministry also said its safer supply program “plays an important role in reducing substance use-related harms” and can lower overdose risk by as much as 91 per cent.
This figure comes from a 2024 B.C. study published in the British Medical Journal. That study found individuals prescribed pharmaceutical opioids early in the pandemic were 91 per cent less likely to die from any cause in the week after receiving at least four days of safer supply opioids, compared to a control group.
The study only tracked outcomes during the week following prescription fills. It did not verify whether individuals took the opioids as prescribed.
A study published in April in The Lancet Public Health shows B.C.’s safer supply programs are linked to improved short-term health outcomes, including fewer overdoses and hospital visits.
However, a population-level study in JAMA Health Forum found no significant reduction in overdoses or mortality associated with B.C.’s safer supply and decriminalization policies. It also suggested possible increases in emergency department visits and hospitalizations.
Comprehensive long-term research on the health impacts of Canadian safer supply programs is limited.
Creating a market
Some sources say the diversion of prescription opioids may be less harmful than the alternatives.
“If you could replace [street] drugs with safer pharmaceutical alternatives, people’s needs would be met,” said Perry Kendall, B.C.’s former provincial health officer and a long-time harm reduction advocate.
“They wouldn’t have to turn to the illicit market, and their risk of a toxic drug overdose would be significantly reduced.”
In Kendall’s view, Schilling was in some ways functioning as a harm-reduction worker.
“[Schilling] was kind of offering a harm reduction service, as well as supplying people with the drugs they wanted,” Kendall said.
Kendall’s views are echoed in a 2023 B.C. government review that notes diversion of safer supply drugs to people already at risk of drug poisoning may be beneficial. But the review also acknowledges that diversion to users who would not otherwise use unregulated drugs is harmful.
Still, Kendall acknowledged a fundamental issue: “[Safer supply opioids don’t] really give you the same high [as fentanyl]. So if you can trade [them] to … get what you’re looking for, which is fentanyl, then that’s what you will do.”
Leonard Krog, the mayor of Nanaimo, says it is clear that, within Nanaimo, B.C.’s policies to help drug users are making it easier for dealers to sell their toxic drugs.
“We have a safe injection site next to City Hall, and there’s no question dealers are coming down here and they’re selling their stuff, because the market’s right here,” said Krog.
But Kendall warns that pulling back on decriminalization and safer supply programs creates a dangerous gap.
“The daftest thing you can do is create a market of desperate people and then fail to fill it,” said Kendall. “Somebody’s going to meet those needs — and they’re not going to be law-abiding citizens.”
Krog is unconvinced.
“If we make it easier for the wolves to successfully exploit the sheep, is that a good thing?”
This article was produced through the Breaking Needles Fellowship Program, which provided a grant to Canadian Affairs, a digital media outlet, to fund journalism exploring addiction and crime in Canada. Articles produced through the Fellowship are co-published by Break The Needle and Canadian Affairs.
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A Canadian poll finds that racial minorities don’t believe drug enforcement is bigoted.
By Adam Zivo
[This article was originally published in City Journal, a public policy magazine and website published by the Manhattan Institute for Policy Research]
Is drug prohibition racist? Many left-wing institutions seem to think so. But their argument is historically illiterate—and it contradicts recent polling data, too, which show that minorities overwhelmingly reject that view.
Policies and laws are tools to establish order. Like any tool, they can be abused. The first drug laws in North America, dating back to the late nineteenth and early twentieth centuries, arguably fixated on opium as a legal pretext to harass Asian immigrants, for example. But no reasonable person would argue that laws against home invasion, murder, or theft are “racist” because they have been misapplied in past cases. Absent supporting evidence, leaping from “this tool is sometimes used in racist ways” to “this tool is essentially racist” is kindergarten-level reasoning.
Yet this is precisely what institutions and activist groups throughout the Western world have done. The Drug Policy Alliance, a U.S.-based organization, suggests that drug prohibition is rooted in “racism and fear.” Harm Reduction International, a British NGO, argues for legalization on the grounds that drug prohibition entrenches “racialized hierarchies, which were established under colonial control and continue to dominate today.” In Canada, where I live, the top public health official in British Columbia, our most drug-permissive province, released a pro-legalization report last summer claiming that prohibition is “based on a history of racism, white supremacy, paternalism, colonialism, classism and human rights violations.”
These claims ignore how drug prohibition has been and remains popular in many non-European societies. Sharia law has banned the use of mind-altering substances since the seventh century. When Indigenous leaders negotiated treaties with Canadian colonists in the late 1800s, they asked for “the exclusion of fire water (whiskey)” from their communities. That same century, China’s Qing Empire banned opium amid a national addiction crisis. “Opium is a poison, undermining our good customs and morality,” the Daoguang emperor wrote in an 1810 edict.
Today, Asian and Muslim jurisdictions impose much stiffer penalties on drug offenders than do Western nations. In countries like China, Saudi Arabia, Iran, Singapore, and Thailand, addicts and traffickers are given lengthy prison sentences or executed. Meantime, in Canada and the United States, de facto decriminalization has left urban cores littered with syringes and shrouded in clouds of meth.
The anti-drug backlash building in North America appears to be spearheaded by racial minorities. When Chesa Boudin, San Francisco’s former district attorney, was recalled in 2022, support for his ouster was highest among Asian voters. Last fall, 73 percent of Latinos backed California’s Proposition 36, which heightened penalties for drug crimes, while only 58 percent of white respondents did.
In Canada, the first signs of a parallel trend emerged during Vancouver’s 2022 municipal election, where an apparent surge in Chinese Canadian support helped install a slate of pro-police candidates. Then, in British Columbia’s provincial election last autumn, nonwhite voters strongly preferred the BC Conservatives, who campaigned on stricter drug laws. And in last month’s federal election, within both Vancouver and Toronto’s metropolitan areas, tough-on-crime conservatives received considerable support from South Asian communities.
These are all strong indicators that racial minorities do not, in fact, universally favor drug legalization. But their small population share means there is relatively little polling data to measure their preferences. Since only 7.6 percent of Americans are Asian, for example, a poll of 1,000 randomly selected people will yield an average of only 76 Asian respondents—too small a sample from which to draw meaningful conclusions. You can overcome this barrier by commissioning very large polls, but that’s expensive.
Nonetheless, last autumn, the Centre for Responsible Drug Policy (a nonprofit I founded and operate) did just that. In partnership with the Macdonald-Laurier Institute, we contracted Mainstreet Research to ask over 12,000 British Columbians: “Do you agree or disagree that criminalizing drugs is racist?”
The results undermine progressives’ assumptions. Only 26 percent of nonwhite respondents agreed (either strongly or weakly) that drug criminalization is racist, while over twice as many (56 percent) disagreed. The share of nonwhite respondents who strongly disagreed was three times larger than the share that strongly agreed (43.2 percent versus 14.3 percent). These results are fairly conclusive for this jurisdiction, given the poll’s sample size of 2,233 nonwhite respondents and a margin of error of 2 percent.
Notably, Indigenous respondents seemed to be the most anti-drug ethnic group: only 20 percent agreed (weakly or strongly) with the “criminalization is racist” narrative, while 61 percent disagreed. Once again, those who disagreed were much more vehement than those who agreed. With a sample size of 399 respondents, the margin of error here (5 percent) is too small to confound these dramatic results.
We saw similar outcomes for other minority groups, such as South Asians, Southeast Asians, Latinos, and blacks. While Middle Eastern respondents also seemed to follow this trend, the poll included too few of them to draw definitive conclusions. Only East Asians were divided on the issue, though a clear majority still disagreed that criminalization is racist.
As this poll was limited to British Columbian respondents, our findings cannot necessarily be assumed to hold throughout Canada and the United States. But since the province is arguably the most drug-permissive jurisdiction within the two countries, these results could represent the ceiling of pro-drug, anti-criminalization attitudes among minority communities.
Legalization proponents and their progressive allies take pride in being “anti-racist.” Our polling, however, suggests that they are not listening to the communities they profess to care about.
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