Running Head: THE OPIOID CRISIS & SOCIAL POLICY 1

Supervised Consumption: The Opioid Crisis and Social Policy

Hannah Maria Wirkkunen – 30042116

University of Calgary

SOWK 632 S02

Robbie Babins-Wagner
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Supervised Consumption: The Opioid Crisis and Social Policy

Canada’s Western provinces have been amidst an opioid crisis for approximately five

years. This paper will examine and analyse the harm reduction and supervised consumption

commitments made by the New Democratic Party identified in their 2017 speech from the

throne. A brief introduction and a history of the Canadian opioid crisis will be provided in order

to understand the current conditions face by the Government of Alberta. Responsibilities and

jurisdictions of the federal and provincial governments will be discussed in relation to social

policy and harm reduction approaches. Lastly, the successes achieved by the New Democratic

Party will be highlighted as positive progress in the fight to ending the opioid crisis, while

criticisms and further concerns will also be provided.

Opiates and Opioids

Opiates are narcotic derivatives of opium, which is extracted from the seedpod of certain

poppy plants (Mosher & Akins, 2014). Some opiates are semi-synthetic, while others are entirely

synthetic, these are referred to as opioids; common opiates include morphine, codeine and

heroin, oxycodone is a semi-synthetic opiate, while fentanyl is a synthetic opioid (Mosher &

Akins, 2014; Fields, 2013). Opiates have been used in medical settings for analgesic purposes for

thousands of years, as their effects include depressed central nervous system, suppressed cough,

and impacts to the nausea centre of the brain (Mosher & Akins, 2014). Although tolerance and

physical dependence does and can occur due to continued opiate and opioid use, the

psychological dependence of such narcotics is said to be the most difficult hindrance to recovery

(Mosher & Akins, 2014; Fields, 2013). Similar to heroin and other opiates/opioids, the overdose

potential for fentanyl is extremely high due to the narcotic being 100 times more toxic than
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morphine, a quantity the size of two grains of salt is toxic enough to kill an adult (Bracken,

2016).

Fentanyl and Opioid Misuse

It is believed that much of the fentanyl in Canada is imported from China, where

chemical companies are custom designing fentanyl and importing the narcotic in packages under

30-grams in an attempt to avoid interception from Canada Border Services Agency officials

(Bracken, 2016). Additionally, fentanyl is simpler to traffic than other narcotics, merely due to

its potency. One kilogram of fentanyl in powder form can be used to produce one million tablets,

sold at approximately $20 each in the city of Calgary, bearing the potential to generate $20

million (Bracken, 2016). Once importers receive the powdered fentanyl it becomes diluted with

materials such as baby powder or powdered sugar, it is also often mixed with other illicit

substances such as heroin and OxyContin (Bracken, 2016). As previously noted, the toxicity and

potency of medical-grade fentanyl is much higher than both morphine and heroin, and it must be

emphasized that medical-grade fentanyl is produced with quality controls in place, while illicit

fentanyl is much of the opposite.

Historically, Canada’s opioid drug abuse mainly involved prescription opioids, however,

over time and possibly due to changes in prescription popularity as well as Health Canada policy

changes, fentanyl has become an overwhelming challenge for all levels of government.

Traditionally, opioids were mainly prescribed to cancer patients to manage chronic pain,

however, in 1996 Health Canada approved OxyContin (brand name oxycodone) as a prescription

narcotic used to treat moderate to severe pain (Bracken, 2016). As OxyContin quickly became

the prescription narcotic of choice, reports of addiction were also increasing throughout Canada

(Bracken, 2016). In 2012, as a response, the producer of OxyContin removed the opioid from
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production and released OxyNEO, a new form of oxycodone that was difficult to crush and

would turn into a jelly-like substance if a user attempted to inject the substance (Bracken, 2016).

The discontinuance of OxyContin and the adaptations to OxyNEO created a void in the extra-

legal market (Bracken, 2016) and left those addicted to opioids in demand of a new substance.

Unlike OxyContin or OxyNEO, fentanyl is produced without government supervision and

imported from beyond Canada’s borders (Bracken, 2016), meaning that the quantity and quality

of each dose differs. Despite the previous redaction of OxyContin from production, physicians

were and still are prescribing opioids for chronic pain, for example, in 2015, Canadian

physicians prescribed enough opioid prescriptions for one in every two Canadians (Bracken,

2016).

Canada’s Opioid Crisis

It is difficult to determine a specific commencement period of Canada’s opioid crisis.

However, investigations have approximated that Canada experienced 2861 opioid-related deaths

in 2016 (Public Health Agency of Canada, 2017; Cotter, 2017). Respectively, British Columbia,

Ontario and Alberta experienced the highest number of apparent opioid related deaths in 2016

(Public Health Agency of Canada, 2017). Though, in reviewing the literature (Public Health

Agency of Canada, 2017; Bracken, 2016), it becomes evident that Alberta and British Columbia

have experienced the greatest number of fentanyl overdose deaths per 100,000 (aside from the

Yukon), prompting a provincial and national urgency to address the opioid crisis at hand.

Additionally, inquiries have determined that fentanyl overdoses have continued to increase in

both Alberta and British Columbia since 2012 (Bracken, 2016). As of November 2017, Alberta

recorded 482 accidental opioid drug overdose deaths, while in November of 2016 Alberta

recorded 346 opioid related overdose deaths, a 40-percent increase (Public Health Agency of
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Canada, 2017; Alberta Health, 2017; Graney, 2017). These statistics represent an approximate

1.8 deaths per day in Alberta as a result of an accidental opioid overdose (Alberta Health, 2017).

Unfortunately, fentanyl overdose does not discriminate and has consequently impacted

individuals of all genders, ages, and socioeconomic statuses across the province (Bracken, 2016;

Bellefontaine, 2017). Contrary to popular belief, fentanyl overdose does not only impact those

living on the streets. Statistics do confirm that a large proportion of fentanyl related overdose

deaths occur among males, at a rate of 74-percent and greatest proportion are between the ages

of 30 and 39 (Scotti, 2017; Alberta Health, 2017).

However, some communities in Alberta have experienced a disproportionate number of

overdose deaths, such as the Kainai Nation, also known as Stand Off, on the Blood Tribe reserve

(Bracken, 2016). A local physician reports that she responded to the community’s first fentanyl

overdose in July of 2014, soon after overdose cases in the small community intensified from two

to three a week (Bracken, 2016). In March of 2015, after months of rising property crime rates,

experiences of destitute poverty, substance abuse, and a disproportionate number of opioid

overdoses, the band council of the Blood Tribe declared a state of emergency (Bracken, 2016).

This complicates the crisis because the wellbeing of Canada’s indigenous reservations are the

jurisdiction of the federal government, requiring government collaboration in addressing the

present issues. Other Alberta communities that have been identified as epicentres of concern are

Calgary, Edmonton, Red Deer, Lethbridge, Medicine Hat, Fort McMurray and Grande Prairie.

Statistics have identified that 81-percent of apparent accidental fentanyl overdose during January

2017 to September 2017 have occurred in larger urban cities such as those previously mentioned

(Alberta Health, 2017).

New Democratic Party Commitments

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The New Democratic Party (NDP) of Alberta won the majority government in May of

2015, this came as a surprise to many Albertans as the province has historically been governed

by the Progressive Conservative Party. The NDP government presented a platform that

committed to decreasing previous cuts to education and healthcare funding (Ramsay, 2015). This

election was timely as is occurred amidst the proliferation of the province’s opioid crisis. In

March of 2017, Lois Mitchell, Alberta’s Lieutenant Governor, addressed the province with a

speech from the throne. The purpose of the speech is to provide Albertans with the government’s

goals and commitments for the upcoming session of administration. The speech addressed topics

such as creating and supporting jobs and making life more affordable for Albertans (Mitchell,

2017). Specific to this critique and analysis, Mitchell (2017) and the NDP government

committed to continue with harm-reduction measures and supervised consumption services in an

attempt to address the province’s opioid crisis. The following portion of this analysis will

investigate the steps taken by the provincial government to adhere to their commitments, as well

as some deficiencies in meeting their assurances.

Canadian Government Responsibilities

Although much social policy responsibility is held by the provinces, the federal

government and the provincial government have specific roles and responsibilities historically

established by the Constitution Act of 1867 (McKenzie & Wharf, 2016). For example, provincial

governments are accountable for the provision of healthcare, social services and education,

among others. While the federal government has jurisdiction over taxation, funding of First

Nations and Inuit reserves according to the Indian Act, as well as law relating to peace and order

(McKenzie & Wharf, 2016). However, the federal government and provincial governments have

arranged cost sharing arrangements that fund programs such as healthcare.

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As mentioned, the provincial governments are responsible for healthcare; however, the

federal government provides large proportions of funding to each province for specific

healthcare initiatives and obligations. However, when the federal government is in political

disagreement with an initiative or provincial policy that depends upon federal funding, it

significantly impedes the chances of successful implementation. For example, the former

Progressive Conservative federal government strictly opposed harm reduction procedures and

policies, choosing rather to endorse the war on drugs and a tough on crime position. The federal

government even attempted to shut down Insite, Vancouver’s supervised injection site in the

downtown Eastside community, despite demonstrating that its services have reduced the

province’s number of drug overdose deaths (Bracken, 2016). Another example of federal policy

directly impacting provincial policy and frontline-practice, is the decision by Health Canada to

remove the prescription requirement on naloxone kits (Bracken, 2016), an overdue decision that

has impacted direct practice of many first responders, but also social workers in community

settings.

Canadian Law and Supervised Consumption Sites

Although healthcare is a provincial responsibility, agencies wishing to operate a safe

consumption centre must apply to the federal government for a Health Canada approval and an

exemption from the Controlled Drugs and Substances Act prior to commencing services.

Specifically, Bill C-37 amends the Controlled Drugs and Substances Act and other interrelated

acts to update the application process for agencies seeking to open a supervised consumption site

(Health Canada, 2017). This Bill has updated the supervised consumption site application

process by reducing the criteria from 26 to 8, reducing the burden of the community and

potential operating site applying for exemption (Health Canada, 2017). Although this is a fairly
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simple and limited investigation of the federal control and influence of supervised consumption

sites, it does highlight that policy change and program implementation at the municipal level

may be beyond the scope of provincial responsibilities and jurisdictions. It must also be

recognized that implementing and commencing harm reduction programs and practices such as

supervised consumption sites can take more time than the government has alluded to in

providing specific commitments and goals. For example, the Associate Health Minister of

Alberta communicated her frustrations with the federal government, as the application process

for Health Canada approved supervised consumption sites has taken much longer than

anticipated (Gerein, 2017).

The previous Alberta government asked the federal government to ban the importation

and operation of industrial pill presses, in November of 2015, however, the federal government

provided no response, at the time (Bracken, 2016). Though this request was not made by the

current NDP government, this request was addressed within Bill C-37, prohibiting the

importation of devices that could potentially be used in production of illicit substances, such as

pill presses (Health Canada, 2017). It is possible that this amendment was successful due to both

past and previous provincial governments seeking assistance from the federal government in

addressing Alberta’s opioid crisis. Additionally, this Bill also sought to remove the

aforementioned 30-gram or less postage exemption that prevented Canadian Border Services

Agency officials from intercepting packages of this weight (Health Canada, 2017). Both of these

policy changes implemented by the federal government will impact the opioid crisis within the

province of Alberta.

Harm Reduction and Supervised Consumption Services

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Harm reduction can be described as any practices, programs and policies that seek to

reduce the potential harms connected to the use of illicit substances (Alberta Health Services,

n.d.). Harm reduction acknowledges addiction as a chronic disease and places emphasis on

reducing harm while using rather than complete abstinence (Alberta Health Services, n.d.; Harm

Reduction International, n.d.). A harm reduction approach identifies that all individuals have a

hierarchy of priorities and at the present time remaining abstinent from illicit substances may not

be of priority, however, of priority for harm reduction services is to prevent irreparable physical

and cognitive damages while continuing to use (Harm Reduction International, n.d.). Similar to

the Canadian Association of Social Workers values and principles, specifically the value of

respect for the inherent dignity and worth of persons (CASW, 2005), harm reduction embraces

dignity and compassion of all individuals by refraining from perpetuating social stigmas of

addiction. In order to engage in harm reduction as a community, or in this case provincially, it is

necessary to challenge national and provincial policies that exacerbate the harms caused to those

living with addiction.

Supervised consumption services are an example of harm reduction practices, programs

and policies. Supervised consumption services offer a safe and hygienic environment to inject,

inhale, ingest and administer substances under the supervision of health care providers in order

to reduce the risk of harm, including overdose and death (Government of Alberta, n.d.). In

addition to offering a safe and clean environment to use substances, supervised consumption

services also provide new and sterile needles and other substance use implements, addiction and

mental health counselling services, and connection to community resources meeting basic needs

such as housing and food security (Government of Alberta, n.d.; Lo, 2018). A client accessing a

supervised consumption service is directed to a sterile room for consumption of the substance
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followed by time spent in a recovery room so the client can be monitored for potential overdose

(Gerein, 2017; Lo, 2018). While in the recovery space clients are able to access addictions

counselling, mental health treatment, as well as connections to social services (Lo, 2018).

Importantly, supervised consumption services are considered to be an evidence-based

approach to harm reduction and contribute to the reduction of HIV, Hepatitis C, bacterial

infections and most importantly overdose death (Government of Alberta, n.d.). The provincial

NDP government has committed to enhancing access to supervised consumption services in the

province of Alberta, however, it is important to consider the role that the federal government

plays in the sanctioning of such policies, programs and practices.

Adherence to Speech Commitments

In March of 2017, the NDP government participated in an emergency meeting with the

province’s opposition parties, who urged the province to declare a state of emergency due to the

ongoing fentanyl crisis (Bellefontaine, 2017). Despite a sense of urgency, the Associate Health

Minister Brandy Payne argued that declaring a public health emergency would not allow access

to increased funds or resources from the federal government (Bellefontaine, 2017; Cameron,

2017b). However, the opposing political party members still contended that declaring a public

health emergency would send a necessary message to the federal government as well as those

who have lost friends and family to overdose, that the Alberta government is addressing the

opioid crisis (Bellefontaine, 2017). Although declaring a state of emergency appears to be a

sensible and relatively simple task, there are a number of policies that regulate the initiation of a

state of emergency declaration.

If the province were to initiate a state of emergency due to concern for the health of

Alberta’s residents, a conventional declaration would be implemented based upon the legislation
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provided within Alberta’s provincial Public Health Act, however, this legislation typically

responds to communicable disease concerns (Cameron, 2017b). Similarly, Alberta’s Emergency

Management Act specifically defines emergency and was written to respond to floods and

wildfires (Cameron, 2017b). In examining the available legislation and policies at the time of the

debate, it becomes evident that declaring a state of emergency as a tactic to address the opioid

crisis is more complex than one would anticipate.

Following the emergency council meeting, in May of 2017, the NDP government

introduced an Opioid Emergency Response Regulation falling under the Public Health Act.

Which previously only catered to health care emergencies with specific criteria, such as

communicable diseases. Additionally, with the public announcement of the new regulation, the

government presented additional commitments, specifically, to expand public drug coverage to

include Suboxone and methadone for those participating in opioid replacement therapy

(Government of Alberta, 2017a). The NDP government also initiated an Opioid Emergency

Response Commission with a mandate of responding to urgent public health crisis needs in

relation to the opioid crisis (Government of Alberta, 2017a). This speaks to the NDP

government’s commitment to their stated obligation of addressing Alberta’s opioid crisis.

Funding

In addition to developing and initiating the Opioid Emergency Response Regulation, the

NDP government has distributed millions in grants throughout the province, giving community

organizations the opportunity to apply to Health Canada for a Controlled Drugs and Substances

Act exception. Furthermore, the government has provided funding specifically for initialization

and operational costs of opening supervised consumption sites. Specifically, in March of 2017,

shortly after the Lieutenant Governor’s speech from the throne, the NDP government announced
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a $45 million increase in funding for addictions and mental health services throughout the

province (Cameron, 2017a). In addition to the provincial government’s contributions to address

Alberta’s opioid crisis, the federal government has contributed $6 million to Alberta’s opioid

plan. At the time of the funding announcement, the allocation of funding was still to be

determined, however, areas of importance included increasing access to naloxone, additional

treatment beds, supervised consumption services and methadone treatment programs

(Government of Alberta, 2017b); commitments that the provincial government addressed during

the speech from the throne.

Successes

As previously noted, the Alberta government committed to distribute funds to community

organizations to assist in the federal application to legally operate a supervised consumption site.

In 2016, prior to the current speech from the throne, the NDP government provided Access to

Medically Supervised Injections Services Edmonton (AMSISE), with a $230,000 grant to apply

to the federal government for a Controlled Drugs and Substances Act exemption in order to

operate supervised consumption site (Bennett, 2016). The provincial government also identified

an additional $500,000 in grants to be distributed to six other Alberta communities in order to

apply for Health Canada approval (Bennett, 2016). Though this funding was distributed prior to

the current throne speech, it highlights the NDP’s provincial support in addressing the opioid

crisis.

Furthermore, the Alberta government has contributed $1.6 million to the Safe Harbour

Society, located in Red Deer, in the form of a grant in order to fund new medical treatment

supports for the detox program that provides clients with methadone or Suboxone; the program

currently has capacity to treat 300 to 400 clients a year (Government of Alberta, 2017c).
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Additionally, Red Deer city council met on the 19th of December to hear the first reading of six

potential community locations being considered for supervised consumption sites (CBC News,

2017). Turning Point, a local agency being considered as one of the potential locations, currently

offers a needle exchange program that distributes 500,000 to 600,000 needles annually (CBC

News, 2017). The city of Edmonton has also been approved by Health Canada to open four

supervised consumption centres, one of which will operate out of the Royal Alexandra Hospital

and will only be accessible to in-patients (Lo, 2018). The Health Canada approval of a

supervised consumption site at Royal Alexandra Hospital is a success because it will be the first

of its kind in North America (Lo, 2018).

Continuing with perceived successes in addressing Alberta’s opioid crisis, Calgary

opened its first supervised consumption site at the Sheldon Chumir Health Centre in January of

2018. Prior to the consumption site opening within the Health Centre, a temporary consumption

site operated within a trailer in the parking lot. In the time that the temporary site was operable,

the clinic had over 2500 visits and prevented 55 overdoses (Lo, 2018). The Government of

Alberta provided $2.2 million in start-up costs for the supervised consumption centre located at

Sheldon Chumir and has committed to providing operational funding for the province’s other

supervised consumption sites scheduled to open throughout the province, including Edmonton,

Red Deer and Lethbridge (Nelms, 2017; Wood, 2016). The aforementioned funding has provided

numerous communities within Alberta the opportunity to contribute to ending the ongoing opioid

crisis.

Commitment Deficiencies and Further Concerns

Both federal and provincial governments have responsibilities in addressing and

managing Canada’s fentanyl emergency, however, both levels of government were slow to make
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policy changes in the beginning months of the crisis. Bracken (2016) argues that the Alberta

government did not issue a provincial warning to physicians regarding illicit fentanyl until late

2014 and it took another year for Alberta’s Health Minister to implement policy allowing first

responders to administer overdose victims with naloxone. Some may believe that the rejection of

harm reduction tactics from previous governments and lack of urgency from the current NDP

government undoubtedly contributed to the flourishing opioid crisis in the province of Alberta.

As the crisis has progressed it becomes necessary to increase federal, provincial, and municipal

resources required to address the needs of those living with an opioid addiction.

Additionally, it could be argued that society has begun to embrace and better understand

mental illness, however, there is still a pervasive social stigma associated with addiction

(Graney, 2017). Those living with an addiction are characterized as morally flawed or blamed for

their substance abuse, however, a significant proportion of opioid addicts were previously

prescribed an opioid analgesic by their physician (Bracken, 2016; Graney, 2017). As such, it

must be acknowledged that not all fentanyl overdoses are occurring within the parameters of the

inner-city, where the abovementioned supervised consumption sites are projected to be located

(Gerein, 2017). This speaks to a continued need for public education surrounding mental health

and addiction, implementing increased education into elementary, high school and post-

secondary institutions could be seen as a preventative rather than reactionary approach to

addiction.

Lastly, arguments have been made stating that responsibility of resolving the Canadian

opioid crisis falls on the supply country, previously identified as China, however, as long as there

is a demand for illicit substances, suppliers will continue to cater to such a need. This argument

highlights the need for cohesion and support from all levels of government, international, federal,
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provincial and municipal. The current opioid crisis reaches far beyond Alberta’s borders and a

multi-political approach is necessary in order to transformation the current conditions. The writer

believes that mental health resources, services and programs should be the utmost importance in

continuing the fight to end the opioid crisis. Again, this is both a preventative and reactionary

approach in the fight against addiction.

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