Alberta to increase access to prescription opioids while limiting locations for treatment

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The Alberta government is expanding access to prescription high-potency opioids to treat substance use disorder while limiting where patients can seek treatment.

Mike Ellis, associate minister of mental health and addictions, announced on Wednesday changes to the province’s Mental Health Services Protection Regulation that will take away the ability for pharmacists and other dispensers to prescribe hydromorphone, heroin and fentanyl as treatment for addictions. Now, only Alberta Health Services will be licensed.

The service is only available to people with severe opioid use disorder, who have been unable to start or stabilize on opioid agonist treatment (OAT) medications, such as suboxone. Patients will now be required to use the high-potency opioids under medical supervision at a licensed AHS clinic – eliminating take-home doses.

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Service providers must have a treatment plan in place before a patient can access the narcotics and are expected to try and transition patients to lower-risk OAT medications.

At a news conference, Mr. Ellis said ensuring supervision of clients will prevent prescribed opioids from being traded or sold on the illicit market and increase public safety. “When it comes to these drugs, the risk to patients and to our communities is simply too high,” he said.

AHS has already taken control of prescribing the three opioids in Calgary and Edmonton and the government said services will be available across the province within five months, at which time current prescribers will have had to transition patients to OAT medications or an AHS clinic.

There are about 350 Albertans currently being prescribed high-potency opioids, mostly from an AHS opioid dependency clinic.

Speakers at the news conference said the advantage of AHS being a centralized health system is that it breaks down health care inequalities, especially in rural areas.

“We were tired of seeing people die of opioid overdoses who never had access to medication options that could reduce their overdose death risk by more than 50 per cent. So we worked tirelessly over the last number of years to bring care to people where they’re at,” said Nathaniel Day, medical director of AHS’ Virtual Opioid Dependency Program.

“Gone are the days where someone living in Drayton Valley needs to hop in their car in the middle of winter and brave icy roads in order to dose at a pharmacy in Edmonton.”

More than 7,400 Albertans have died by unintentional drug overdoses since 2016, the majority linked to opioids such as fentanyl. While overdose deaths have dipped since a spike late last year, deaths remain far above prepandemic levels.

In March, 2020, the province said it would discontinue funding for its injectable opioid agonist therapy program, or iOAT, which offered hydromorphone by injection up to three times daily for patients who were unsuccessful on oral treatments, such as the ones offered through OAT.

After a lawsuit was brought against the government, arguing the closings would breach protected rights, the province agreed to continue funding the program for existing clients. However, no new clients were accepted.

Addictions physician Monty Ghosh said in an interview that while it’s not exactly iOAT, the province’s direction encompasses many aspects of the program that made iOAT successful, such as a range of support services, access to injectable forms of opioids and a chance for some people to have a “last chance” at recovery.

He said this will open access to the medications like never before in Alberta and is confident there are safeguards in place to ensure people who do not want to undergo OAT will still be able to access the higher-risk prescriptions. But he said disallowing community groups from prescribing and ensuring medical oversight could be a barrier to access.

“This is not safe supply. This doesn’t follow the principles of safe supply, which is a harm reduction strategy, but this does open up a lot of options for clients who do not do well with traditional treatments,” said Dr. Ghosh.

Euan Thomson, co-founder of Each and Every, a group of businesses advocating for harm reduction in Alberta, said the provincial announcement is a step forward for access to a regulated drug supply but “two steps backward” because it requires too much medical oversight.

He said he is concerned about the proximity and practicality of having to access prescriptions at AHS clinics, especially for people who use multiple times daily or who have had negative experiences with the medical system because of their drug use.

“This is simply one more set of handcuffs on people who use drugs,” Mr. Thomson said.

“The singular focus on addiction treatment is unfair and lacking evidence, when we know well by now that it is the toxicity of the drug supply that drives death. People who plan to continue their drug use will have no other option but to remain exposed to what is available in the unregulated market.”

The announcement also came just one day before the United Conservative Party announces a new leader, which could halt progress of this plan. But Mr. Ellis said he has spoken with most leadership candidates and they are “absolutely supportive” of the current mental health and addictions strategy.