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Massive funding boosts kick off Alberta’s transition to fully comprehensive care

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Dr. Paul Parks, president, Alberta Medical Association

Canada signs more than $1 billion bilateral agreement with Alberta to improve health care over three years

This investment will increase access to a primary health provider, reduce wait times for mental health services, and provide greater access to health data.

Canadians want and deserve a health care system that provides timely access to health services whenever and wherever they are needed. That is why the Government of Canada is investing over $200 billion over 10 years, which includes $25 billion for tailored bilateral agreements with provinces and territories, to support the Working Together to Improve Health Care for Canadians plan.

Today, the Honourable Mark Holland, Canada’s Minister of Health, and the Honourable Adriana LaGrange, Alberta Minister of Health, announced a bilateral agreement to invest $1.06 billion over the next three years, marking a crucial step in a 10-year plan for collaboration. This includes $285 million per year in new funding by the Government of Canada and continuing $70 million per year in previously-announced mental health and substance use funding, which will help accelerate efforts already underway in Alberta to improve health care access and services.

Through this federal funding, Alberta has a three year action plan to deliver improvements to its health care system by 2026, including:

  • Increasing access to primary care providers for Albertans and reducing emergency department visits that could have been addressed by a family medicine office. This will be achieved by expanding team-based care and enhancing virtual care, and increasing the number of appointments available to patients.
  • Funding community providers to increase diagnostic imaging capacity in the province, reducing wait times for CT scans and MRIs.
  • Improving patient care by enhancing Albertans’ ability to access digital health services and their own health information by implementing e-referral services and accelerating the secure exchange of data across the health system.
  • Expanding integrated services for youth mental health services in the province through school-based and community day programs, and offering more supports for youth with complex needs as they transition into adult services.
  • Reducing median wait times for community mental health and substance use services by establishing new and improving existing treatment spaces, along with prioritizing culturally appropriate Indigenous community supports.
  • Ensuring that First Nations and Métis people have access to high-quality, culturally safe care that meets their unique health needs. This will be achieved through dedicated funding for initiatives to enhance access to primary care in Indigenous communities, and funding for communities to develop health workforce capacity and infrastructure to improve the collection and use of health information and data.
  • Improving access to health care for underserved Albertans, including through expanded community pilots that bring testing services to rural, remote and Indigenous communities, advancing French-language health services, and greater clinical care for women.

Progress on these initiatives and broader commitments will be measured against targets which Alberta will publicly report on annually.

Through this new agreement, Alberta will improve how health information is collected, shared, used and reported to Canadians; streamline foreign credential recognition for internationally educated health professionals; facilitate the mobility of key health professionals within Canada; and fulfill shared responsibilities to uphold the Canada Health Act to protect Canadians’ access to health care that is based on need, not the ability to pay.

Recognizing the significant disparities in Indigenous health outcomes, the Government of Canada and the Government of Alberta also commit to meaningfully engage and work together with Indigenous partners to support improved access to quality and culturally appropriate health care services. Alberta’s action plan is informed by continued engagement with its Indigenous partners and recent discussions involving the federal government. All orders of government will approach health decisions in their respective jurisdictions through a lens that promotes respect and reconciliation with Indigenous Peoples.

Alberta and the federal government will continue working together to improve access to health services and deliver tangible results to all residents across the province, including responding to the needs of Indigenous and other underserved and disadvantaged populations.

Quotes

“Our government is working together with provinces and territories to get Canadians the healthcare they need. This agreement is an important step in our collaboration with Alberta to take measurable actions to transform our health care system. The funding will help improve access to primary care and create better mental health services in Alberta. Together, we will continue working to achieve better health outcomes for all Canadians.”

The Honourable Mark Holland
Minister of Health of Canada

“Mental health is health, and through this agreement, we will be working with Alberta to integrate mental health and substance use care as a full and equal part of our universal health care system. This agreement will strengthen the capacity of family health providers, reduce substance use harms, and expand virtual care for youth to improve access to quality and timely mental health care and substance use supports. Together, we must ensure that all Canadians have access to supports and services for their mental health and well-being – when they need them, wherever they need them.”

The Honourable Ya’ara Saks
Minister of Mental Health and Addictions and Associate Minister of Health of Canada

“Alberta’s government is taking a serious look at the way health care is being delivered in our province. This is why we are refocusing our health care system to ensure Albertans have access to timely care, when and where they need it. This initial funding from the federal government is a good start and will support our shared health priorities of expanding access to primary care across the province and especially in our Indigenous communities, supporting our health care workers, improving access to quality mental health, and modernizing our health systems.”

The Honourable Adriana LaGrange
Minister of Health of Alberta

“Alberta’s government is supporting Albertans to improve their mental health and recover from the deadly disease of addiction as we build out the Alberta Recovery Model and refocus our provincial healthcare system. We are doing this by increasing access to CASA Mental Health Classrooms across the province, building more bed based mental health treatment capacity for youth, and improving access to mental health and addiction treatment services in communities. This initial funding from the federal government will offer some support to these made in Alberta initiatives as we build a better system of mental health and addiction care for Albertans.”

The Honourable Dan Williams
Minister of Mental Health and Addiction of Alberta

Quick facts

  • The Working Together investment includes $25 billion for tailored bilateral agreements with provinces and territories, a guaranteed 5% Canada Health Transfer (CHT) increase for the next five years—amounting to $17.5 billion—and a one time CHT $2 billion top-up to address urgent needs of emergency rooms and paediatric hospitals delivered in June 2023. Combined, these investments provide provinces and territories the flexibility to address the unique needs of their populations and geography, and accelerate health care system improvements.
  • Budget 2023 outlined the Government of Canada’s plan to invest over $200 billion over 10 years, including $46.2 billion in new funding for provinces and territories, to improve health care for Canadians. Within this funding, $25 billion is allocated through tailored bilateral agreements to address the unique needs of their populations and geography in four shared health priorities:
    • expanding access to family health services, including in rural and remote areas;
    • supporting health workers and reducing backlogs;
    • increasing mental health and substance use support; and
    • modernizing health care systems with health data and digital tools.
  • All provinces and territories are already making considerable investments to advance progress in all four of these priority areas, and the new federal funding is complementing and expanding those efforts.
  • As part of these bilateral agreements, provinces and territories are developing action plans that outline how funds will be spent and how progress will be measured to demonstrate to Canadians that improvements are occurring in Canada’s health care system. Alberta’s initial 3-year Action Plan can be found here.
  • Budget 2017 committed $11 billion over 10 years in federal funding to provinces and territories to improve access to home and community care, and mental health and addictions services for Canadians. Bilateral agreements were signed with provinces and territories to access the first six years of funding. The final four years of funding for mental health and addictions are included in the new Working Together bilateral agreements.
  • The Government is also working with provinces and territories to implement a second bilateral agreement focused on helping Canadians age with dignity close to home, with access to home care or care in a safe long-term care facility. This agreement will include the remaining $2.4 billion over four years to improve access to home and community care from Budget 2017; and the $3 billion over five years for long-term care from Budget 2021 to apply standards of care in long-term care facilities and help support workforce stability.

———-

From the Province of Alberta

This funding will be an essential transitional step to ensure doctors can continue to provide this care as we rapidly transition to a funding model that supports fully comprehensive care.”

Dr. Paul Parks, president, Alberta Medical Association

New funding to stabilize primary health care

Stabilization funding is coming soon as Alberta’s government continues working to improve primary health care across the province.

The government is pulling out all the stops to stabilize, strengthen and improve Alberta’s primary health care system. Additional funding of $200 million over two years will improve access to family physicians and help ensure primary health care is available for every Albertan when and where they need it.

This funding is enabled through the new Canada-Alberta Health Funding Agreement with the federal government. The agreement represents a total of approximately $1.1 billion in additional health care funding over three years for shared priorities.

“We have been clear: Albertans must be able to access the primary care they need, and family physicians are critical to that care. We are prepared to do the hard work necessary to close the gap between Albertans needing care and those who are able to provide it, and this is one more step forward. We will continue to work with the AMA and all our partners to ensure that our health care system is one Albertans can be proud of.”

Danielle Smith, Premier

Stabilization funding is an important transitional measure identified through work under the memorandum of understanding (MOU) between the minister of health and the Alberta Medical Association (AMA), signed earlier this fall. The AMA has been advocating for family physicians and rural generalists through its work under the MOU. Alberta’s government will continue to engage with the AMA as it works to develop a new, sustainable physician comprehensive care model, which will also dictate how this additional funding will be distributed.

In addition to work between the government and the AMA, the Comprehensive Care Task Force will, in the new year, provide a first draft of recommendations that will include additional short-term stabilization actions to help family doctors continue to practise comprehensive care and bridge the gap until a new physician comprehensive care model is developed.

These short-term actions will:

  • Address key issues or pressures in the system such as doctor retention, administrative burden and inflationary costs.
  • Be implemented quickly and efficiently.
  • Be transitional until the new payment model is ready.

“We are committed to securing primary health care as the foundation of the entire health care system, and family physicians are fundamental to our plan. I committed to work with the AMA to identify immediate measures to improve primary health care and this is exactly what we are doing through this funding. It will help stabilize the system as we transition to a new physician comprehensive care model, so Albertans can receive the health care they need and deserve.”

Adriana LaGrange, Minister of Health

Alberta’s government is committed to finalizing a sustainable physician comprehensive care model that will address the concerns of family physicians and rural generalists and ensure Albertans can access the care they need.

“Our doctors want to provide comprehensive, lifelong care for patients and we are encouraged to have the opportunity to work collaboratively with our provincial government. The reality is family physicians and rural generalists have truly been struggling to maintain viable practices. This funding will be an essential transitional step to ensure doctors can continue to provide this care as we rapidly transition to a funding model that supports fully comprehensive care.”

Dr. Paul Parks, president, Alberta Medical Association

Other recently announced supports for primary health care include:

  • Ongoing base compensation for primary care physicians is expected to be $1.76 billion in the current fiscal year.
  • Committing to create a primary care organization within the refocused provincial health care system to coordinate primary health care services and provide transparent provincial oversight, with the goal of ensuring every Albertan will be attached to a family physician or primary care provider.
  • Investing $57 million over three years to provide family doctors and nurse practitioners with support to help manage their increasing number of patients.
  • Investing $40 million over two years to support Primary Care Networks.
  • Investing $12 million for the Community Information Integration and Central Patient Attachment Registry, enabling doctors and their teams to share patient information from their electronic medical record to Alberta Netcare.
  • Committing to implement recommendations from the Modernizing Alberta’s Primary Health Care System initiative through a phased approach.
  • Creating a primary health care division within Alberta Health.

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Alberta

Alberta gets credit boost because of budget discipline

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News release from the Canadian Taxpayers Federation

Author: Kris Sim

“bringing net adjusted debt to an estimated CAD 57.5 billion in fiscal 2024 (ended on March 31) from CAD 74.6 billion in fiscal 2022”

The Canadian Taxpayers Federation is applauding the Alberta government for its fiscal discipline which earned the province a boost in its credit rating.

“Alberta is one of the only provinces in Canada with a balanced budget, and it shows with this credit upgrade,” said Kris Sims, CTF Alberta Director. “Paying down the debt, restraining spending and saving for the future were very good moves by this government.”

In its most recent budget, Alberta reported a $367-million surplus. That stands in contrast to neighbouring Saskatchewan’s $273-million deficit and British Columbia’s record-breaking $7.9-billion deficit.

The rating agency, Fitch, upgraded Alberta’s credit from AA- to AA this week, highlighting its debt repayment as a key reason for the improvement.

“Alberta used its recent economic rebound to accelerate fiscal improvements and lower its debt, bringing net adjusted debt to an estimated CAD 57.5 billion in fiscal 2024 (ended on March 31) from CAD 74.6 billion in fiscal 2022,” the Fitch report reads.

The agency also cited Alberta’s spending restraint as a reason for the positive outlook.

“The rapid decline in debt and adherence to spending restraint in recent budgets have been complement with last year’s introduction of a fiscal framework requiring balanced budgets, annual contingencies and using surpluses for debt repayment, savings or one-time investment, is likely to bolster future resilience,” the Fitch report reads.

Interest charges on the province’s debt are estimated to cost taxpayers $3.3 billion this year.

“Credit ratings matter because Albertans pay billions of dollars on interest payments on the debt every year, better credit ratings make it less expensive to pay for that debt, and the less money we waste to pay debt interest charges the better,” said Sims.

 

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Addictions

Alberta and opioids III: You can’t always just stop

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Monty Ghosh at Highlevel Diner, May 30.                                                                            Photo: Paul Wells

This is the concluding installment in a series on drugs in Alberta. Previously:

i. “Worse Than I’ve Ever Seen,” June 4

ii. “Alberta’s System Builder,” June 7


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A matter of expectations

Street family

My tour guide for much of my visit to Edmonton was Dr. Monty Ghosh, a clinician who’s on faculty at the University of Calgary and the University of Edmonton. He seems to talk to everybody who works with substance users in Alberta, from his own patients to front-line clinicians to the Alberta government. His relations with the latter go up and down, but he urged me to talk to Marshall Smith, the chief of staff to premier Danielle Smith.

On my first night in Edmonton Ghosh walked me around a neighbourhood that included the George Spady Society  supervised-consumption site, the Hope Mission’s Herb Jamieson Centre, and the Royal Alexandra Hospital, which has a supervised-consumption service on its premises.

A lot of people use the services these places provide. Other people don’t. Shelters in particular are tricky: they’re usually for single people who arrive alone. “The Hope, the Herb, the Navigation Centre, offering the world,” one Edmonton Police Service officer told me. “But all these places have one thing in common: rules.” If you have a spouse or a pet, you want to keep your drug supply or you want to stay close to your “street family” — the community spirit in neighbourhoods like this is striking, and might be surprising to people who prefer to stay away — a shelter’s probably not for you.

Several of the places we visited weren’t ready to welcome us when we showed up unannounced. To say the least, they’re busy. That was the case at Radius Community Health and Healing, an institutional building in a more residential part of the neighbourhood. Radius is a drop-in clinic and, as we’ll see, quite a bit more.

On a sunny weekday afternoon, more than a dozen people stood, sat or lay on the building’s front steps and truncated lawn. One lay on his back, shirtless, not moving visibly. Ghosh asked the man whether he was all right, asked again, finally nudged him. The man stirred, looked around. Ghosh apologized mildly for bothering him, then checked in on two other people who also weren’t moving. They turned out to be all right too.

Francesco Mosaico, Radius’s medical director, was on his way home for the day when we arrived, but we made plans to talk the next day. When I returned, I met Mosaico and Radius’s executive director, Tricia Smith, in her office.

I think it’s important to hear them out, because when drug use becomes the object of political debate, it’s natural to talk as though policy decisions are the main thing keeping people from getting well. This can lead to a lot of blame on one hand, and to excessive optimism on the other. In fact the biggest thing that keeps people from getting well is often the entire sum of their lives until now, compounded by the influence of drugs that are more potent than anything earlier generations had to deal with.


The most complex patients

Radius offers primary care to people “experiencing multiple barriers,” Smith said. That can include homelessness, addiction, severe mental health problems, criminal records. The centre’s team includes 12 family physicians and three psychiatrists. They currently see about 3,000 patients.

Radius has Western Canada’s only non-profit dental clinic. The centre runs a respite program for people who are not sick enough to be in acute care but are too sick to be managing independently on their own. It has a program for pregnant women experiencing homelessness. It runs on a harm-reduction model, so they don’t need to be drug-free to go into the program. It has an interdisciplinary Assertive Community Treatment team to help people with mental-health and substance problems find and stay in market apartments, with frequent assistance. There’s a supervised consumption site in the basement.

“In fact,” Smith said, “we actually have an exemption from the College of Physicians and Surgeons of Alberta to filter out and keep the most complex patients. The least complex, we refer elsewhere.” I couldn’t get care in Radius if I tried; they’d politely refer me elsewhere. They’re for the people who need the most help.

After my visit, Smith wrote to me to add another program to the list: Kindred House, which for more than 25 yearss has supported women and Trans women sex workers. “The women we see are from age 18 to 50, predominantly Indigenous, have intergenerational trauma, past/current trauma, substance use issues, often houseless or couch surfing,” Smith wrote.

Smith has been at Radius for three and a half years. While I was there, I asked her how work at Radius is going. “It’s going fabulously, honestly,” she said. She arrived early in the COVID pandemic, after eight years in Alberta government departments — which in turn followed 20 years as a Canadian Forces army nurse, including in combat zones. “I’m in the right place,” she said of Radius. “It felt like coming home.”

How come? “The staff, the team, the work, the dedication. It just feels like family. I missed that. Being in the military was a big thing. This work that this group does is just really amazing. The team is amazing and it’s hard, but it’s good work.”

And how’s the workload evolving? “Unfortunately, for this population, the struggles are only increasing, and the number of individuals that are experiencing those challenges is not getting less,” she said. “The workload isn’t going anywhere. It’s getting more difficult.”

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“Especially in the last couple years, I don’t think things have ever been worse for the vulnerable population,” Mosaico, Radius’s medical director, added. The same housing crunch that has made homes less affordable for everyone has put thousands of the most vulnerable on the street. Results: more frequent frostbite or burns from lamps lit to keep from freezing. Body lice. Trauma from watching friends die. And to Mosaico’s astonishment, frequent shigella outbreaks.

“Shigella’s a bacteria that causes torrential bloody diarrhea. It can be treated with a single dose of antibiotics. But if you’re homeless and you don’t have a place to take care of yourself… 70 percent of the cases have had to be hospitalized in the last two years…. I mean, they’re talking about potentially calling it an endemic disease, and it’s a disease of destitution. You see it in refugee camps in developing countries, not in the capital of Alberta, you know?”

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Ten thousand times deadlier

Radius also works closely with the Alberta government to integrate its services with the “recovery-oriented system of care” that I told you about last week. There are two Radius staffers working at the Integrated Care Centre the police set up to replace the old, passive holding cells for overnight detention. There are two more at the Navigation Centre, which steers people toward social and government services. If there’s an Alberta model, they’re part of it. So I was fascinated by the response when I asked my hosts the basic question that sent me to Alberta: Why are so many people dying?

“I think it’s the nature of the drugs,” Mosaico said. “You know, people used to overdose and die. But I’ve been here 17 years. I think in the first 10 or 11 years it wasn’t very common to hear about overdoses by opioids. Every once in a while you’d hear about it, but it wasn’t a daily thing. Whereas now with fentanyl and carfentanil, it’s really dangerous.”

Carfentanil is 10,000 times more potent than morphine, 100 times more than fentanyl. The Edmonton Police won’t return stolen cars they recover until they’ve scrubbed them thoroughly, because even trace amounts of these drugs are too dangerous. “We’re finding clients who use methamphetamines and swear up and down they’re not taking opioids,” Mosaico said. “And then we do urine tests and it’s there. We think their dealers are lacing methamphetamine with fentanyl because it increases the addiction.”

The other big thing on his mind, Mosaico said, is that any program to guide users into recovery will bump up against the fact that different people have often lived starkly different lives.


93% 4+

“I don’t know if you’re familiar with Adverse Childhood Experiences — the ACEs study,” Mosaico said. I was, barely, but I needed a refresher.

The original study began in 1985 in San Diego, under Vincent Felitti, who ran an obesity clinic, and Rob Anda from the Centres for Disease Control. (If you want to learn more about the study, this article and this speech on Youtube are good places to start.)

“They surveyed 17,000 people,” Mosaico said. “They found, you know, if people had developmental trauma — so, trauma between the ages of 0 and 18 — and there are 10 different forms of trauma that the study bore out as being detrimental. Things like physical, emotional, sexual abuse; physical, emotional neglect; substance use in the family; untreated mental illness in the family; separation from biological parents; maternal figure being treated violently; and a household member going to jail.

“If those things occurred, you would just tally up the number of types of trauma and you’d get a score out of 10. What they found was, if you scored four or greater, that there seem to be adverse health effects in adulthood. And it wasn’t just the presence of addictions or mental illness. It was lung disease, heart disease, liver disease, certain forms of cancer, diabetes, obesity.” This is almost folk wisdom today, but at the time, Felitti and Anda were amazed at the strength of the correlations between childhood trauma and adult physical and mental health.

The original test has been widely replicated, and it usually finds that the proportion of people in a sample who’ve had four or more adverse childhood experiences is about 12%. So something like every eighth person you meet had a really difficult childhood, and while you can’t predict for individuals from statistical trends, there’s a good chance they’re still living with the fallout.

The team at Radius surveyed a large sample of the population under their care. The prevalence of high-risk ACE scores was about 93 percent, compared to 12 in the general population,” Mosaico said.

“Harvard has a center on the developing child, which has pulled together a lot of the science that explains the neurobiological link between the adverse trauma and the adverse health effects. They talk about limitations in the development of executive function, of decision-making, emotional regulation. Impulse control is underdeveloped, neuroanatomically in the brain. And instead what over-develops is the fight-or-flight response.

“So you’re dealing with a population that, because of their experiences, isn’t the same as the general population . And then that’s compounded by the fact that a high percentage of those clients who have high ACE scores also have traumatic brain injuries from living rough on the street. They also have adult trauma that compounds the childhood trauma. They have [fetal alcohol spectrum disorder], which impairs executive function even further.

“I hear these success stories and I think they’re wonderful, when you hear about people who have a difficult life and then they straighten up. And then, you know, they go back to their jobs and their families and they become leaders in their communities. But this is a population which is over-represented in every aspect of society, negatively as it were. In the prisons and child family welfare services. In the health system, you know, prevalence of HIV, tuberculosis, Hepatitis C, STIs, all that.

“And you look at them and you think, even if they managed to wait, you know, six months to get into an addiction recovery bed, after waiting for weeks to get into detox and they go through the program, what do they go back to? Most of them had to drop out of school. They have criminal records, which makes it hard to get a job. They’re disconnected and estranged from their families. They haven’t learned social skills.

“I had a client who lived in dumpsters for two and a half years. The fact that he just stayed housed — on income support — for the rest of his life was a huge win, right? It was important for his dignity, his quality of life. It’s just a matter of adjusting your expectations of what might actually be realistic.”

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Dr. Larson writes

The idea for these stories goes back to February, when it first became clear to me that 2023 would be Alberta’s worst year for overdose fatalities. I asked the communications team at the University of Calgary for names of people to talk to. Many weeks went by, because sometimes it’s ridiculous how hard it is to extract myself from Ottawa routine. After I published the second article in this series, the one where Marshall Smith showed me all the stuff Alberta is building, I received an email from Dr. Bonnie R. Larson, who’s on faculty at the University of Calgary. She thought I should have talked to her, and she thought I was too credulous in reporting the Alberta government’s side. I asked if I could publish part of her email. Here it is.

What cannot be taken for granted is Mr. Smith’s view that his goals are different, somehow nobler, than those of us on the front line.  Smith paints a picture that front line providers’ priorities are at odds with his own.  His perspective is at once undemocratic, insulting, and arrogant, belittling those who are doing the hard work of keeping people alive every day.  

I will not have Smith speak for me in his suggestion that front liners lack system knowledge and that is why we support harm reduction. This ignores the excellent evidence supporting harm reduction interventions at the population level.  Smith seems to think he knows from whence I “enter this conversation”.  If so, why does he not engage me and my expert colleagues?  Where I “enter this conversation” is at 20 years of working with the affected community and 13 years of post-secondary education.  The only reason I am what Smith likes to dismiss as a “radical harm reduction activist”, is because the UCP, immediately upon taking office, set out to destroy harm reduction in Alberta.  Nobody would have ever needed to fight this soul-destroying battle in the first place if Smith hadn’t put Alberta squarely on its current path of destruction. Yes, we should hope for a better tomorrow but that doesn’t excuse ignoring the past and present.  

I would ask you to think about several additional factors that your analysis appears to ignore, including who actually benefits, in power and wealth, from Smiths’ system of so-called care?  DId you consider the other ways that the UCP policy direction is moving the entire publicly-funded system steadily towards profit?  Gunn (McCullough Centre) was a wonderful non-profit facility that helped many of my patients find their way to recovery from substance use disorders. While I agree that people should not have to pay for treatment, the question remains:  in whose pockets do those tax dollars ultimately land?

You report that Smith indicates that they are “monitoring” the entire system.  Where is the data from that monitoring?  They have had five years now to show some outcomes, but who am I, just a lowly street doctor, to ask for population data?  What I do know is that if deaths begin to decline, it is because so many are already gone.  You should ask to see the data about which Smith so proudly boasts.    

Smith’s entire premise that he is fixing the ‘addiction crisis’ is a fallacy.  Addictions are not increasing.  Deaths by drug poisonings are, however, and Smith’s circus is only making that worse.  Allow me to spell it out for you:  harm reduction addresses the drug poisoning crisis that is, no question, taking a horrific toll in Alberta and nationally.  Smith’s ROSC, in contrast, addresses a figmentary addictions crisis.    

One last tip. Medications used for opioid agonist treatment are not harm reduction, they are treatment.  Nobody here is against treatment or recovery.  But Marshall Smith is against harm reduction.  Why can’t we just have the full spectrum of care???  Polarization is created by politicians to benefit politicians.   

I don’t endorse everything Dr. Larson writes here. The data, or a lot of it, seems to me to be publicly available on the province’s impressive dashboard website. Use the tabs at the top of the page to navigate. And indeed, the story the dashboard tells is alarming, which, as I explained in this series’ first instalment, is why I flew west. But Larson’s years of front-line work has earned her, at the very least, a right of rebuttal.


Synthesis

On my last day in Edmonton, I met Monty Ghosh at Highlevel Diner, at the outer edge of the hip Strathcona neighbourhood on the south of the North Saskatchewan River. Highlevel is famous for its cinnamon buns, which, if I’m going to be honest, are noteworthy mostly for being large.

If the Alberta government and its most vociferous critics are thesis and antithesis, Ghosh tries to provide synthesis. He helped design the National Overdose Response Service, or NORS, which provides some of the emergency-response capability supervised consumption sites offer to people who aren’t near such a site or can’t use it for other reasons. He’s been critical of the Alberta government, but both sides keep lines of communication open.

I asked him about diverted safe supply — the idea that pharmaceutical opioids used in safe-supply programs in BC, principally hydromorphone tablets, are being sold or distributed away from their intended use. “I know it happens,” Ghosh said. “We sometimes get clients from British Columbia who come to Alberta to try to escape BC, because they’re looking for a fresh start. They’re looking for support and they’ll tell me themselves that they’ve diverted their safe supply.”

But what are the quantities? Trivial so far, Ghosh maintains. “Have I seen hydromorphone come into our province? Not at all, not yet.” This is the same thing I heard from Warren Driechel, the Edmonton deputy police chief.

Why do people divert their prescribed safe supply anyway? The answer Ghosh gave me was the answer I heard from everyone I asked. “They never used it. It just was not effective. The potency of the hydromorphone that they’re getting was nowhere near touching the fentanyl that they were using. It wasn’t dealing with the cravings, it wasn’t dealing with withdrawals, they felt it was useless. So what did they do? They sold it. They’re incredibly poor, they cannot afford their substance-use concerns and so therefore they supplement with revenue from hydromorphone.”

Before I flew to Edmonton, when Ghosh and I were trying to gauge on the phone what each of us thought of this infernal crisis, he figured out that I was interested in the differences between government policy in British Columbia and Alberta. “I’m not sure you want to hear this,” he said, “but I think it’s going to be bad everywhere.” I said that’s what I think too. Perhaps I surprised him.

I don’t know what happens next. Maybe things just stop getting worse everywhere on their own, for big complex reasons that resist easy analysis. Overdose deaths were lower last year in the United States, the capital of this hellscape, than the year before.

If not… well, we shall see. I wonder what happens in year six or seven of the effort the Alberta government is building. Is there resentment among people in ordinary hospitals and correctional facilities, who don’t have access to bespoke programs and personal attention? Does the ROSC system become bureaucratized after the first generation of administrators moves on?

Or does it start to win converts? David Eby, the NDP premier of British Columbia, has started putting distance between himself and his public-health advisors on legalization and safe supply. A new appointment in BC is being closely watched in Edmonton.

Or, conversely, does the Alberta recovery effort bump up against the limits imposed by the substances involved and by human nature? Reported recovery rates from addiction vary widely, depending in part on how you measure them. This paper puts the rate at less than 30%. If you even manage to double it, that still leaves a large cohort who aren’t getting better. Would their neighbours see them as people who “failed recovery” or “blew their chance?”

I won’t claim to know. I do hope that in the year ahead, more Canadians check their assumptions and stow their cheap certainties. Especially those who aspire to positions of leadership.

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